Transitioning to the next wave
The COVID-19 pandemic has lifted a number of bioscience concepts from academic obscurity into everyday awareness. One erstwhile arcane concept is “flattening the curve” to avoid a steep spike of infection so that we do not overwhelm society’s capacity to deal with the cases that require medical attention. Another now familiar notion, that of “herd immunity”, postulates that once enough people are not susceptible to a pathogen, the infection rates drop, and the disease peters out. Flattening the curve is the immediate priority while herd immunity is needed to minimise long term impact.
At the time of writing (late April 2020), the measures taken around the world to restrict movement and person to person contact appear to be helping to flatten the curve, but these restrictions cannot be maintained indefinitely. Once the world comes out of lockdown, there is the very real risk of second and subsequent COVID-19 waves. One way to minimise the impacts of these waves is to adopt lifestyle practices that can help to strengthen peoples' immune systems to minimise infectious disease severity.
The practice Julie and I have adopted comprises of an integrated approach encompassing seven interlinked pillars of a healthy lifestyle:
I will introduce this approach in this article and list some of the practices I undertake to optimise my health. For a more personalised, practical, and in-depth understanding you can sign up for one of our participatory workshops or take part in one-one or small group coaching.
This and other articles that address SARS-CoV-2 and immune function are based on the logical assumption that improved immune function will help to limit the severity of infection from this particular virus. However, this cannot be definitively concluded until there is targeted research to confirm this underlying assumption.
What we do know is those that suffer certain pre-existing conditions are much most vulnerable to COVID-19 than those who do not. A CDC report published in late March stated that 94% of all the people who have died from COVID-19 in the US to date had an underlying chronic condition such as type 2 diabetes, hypertension, cardiovascular disease, chronic lung disease, and obesity (CDCMMWR, 2020). The equivalent figure in Italy was 99% (COVID-19 Surveillance Group, 2020). The lifestyle interventions outlined in this article have been shown to prevent, arrest and even reverse the chronic conditions that serve as coronavirus welcoming mats.
1. A Wholefood Plant-Rich Diet
The following diverse and consistent evidence base indicates that a whole food plant-rich diet is optimal for human health:
There is insufficient evidence to assert that a wholefood vegan diet is any healthier than a regime that incorporates small quantities of animal products 1-3 times per week. This is why we use the term ‘plant rich’ rather than plant based. Our approach is summarised in the New Paradigm Health Wholefood Plant-Rich Diet Plate derived from the work of Fuhrman (Fuhrman, 2011), Popper and Merzer (Popper and Merzer, 2013), and Davis and Melina (Davis and Melina, 2014).
The categories can be broken down as follows:
For an excellent summary of the power of plants to contribute to a healthy immune system, I recommend you read the article by Ocean Robbins - Smart Immunity: How Diet and Lifestyle Can Help You Stay Healthy in the Time of COVID-19. Robbins uses Joel Fuhrman’s handy acronym G-BOMBS to introduce the power of healthy foods to positively influence your immune system. G-BOMBS stands for greens, beans, onions, mushrooms, berries, and seeds. But remember, the power in the individual foods is manifested in the dietary pattern of which they are a part. There is little benefit in eating flax seed (ground not whole) for its omega-3s while guzzling down gallons of Coca Cola and binging on greasy kebabs. Superfoods are no longer super if they are part of a dietary pattern that minimises nutritional kryptonite.
Julie and I eat a wholefood vegan diet with no added sugar or wheat products and very little oil. We eat organic as far as possible.
As might be evident, I prefer to get my nutrition from whole foods rather than from pills. Whole foods contain a complex of macro and micronutrients in a form our bodies are designed to absorb (Campbell and Jacobson, 2014). A focus on individual nutrients reflects a reductionist mindset prevalent in both the conventional and complementary health spheres. That being said, there can be instances when taking individual nutrients or other supplements is justified and an individualised regime may be required. Being a vegan, I take vitamin B12 (1,000 mcg, 3 times per week). B12 is produced by microbes that live in the environment and are ingested by animals. I also regularly take vitamin D (1,000 IU per day from October – April), quercetin (500 mg once per day) for gut health, and an algae-based source of omega 3 DHA (400 mg per day). At the first sign of an infection I take vitamin C to bowel tolerance and zinc (50mg per day).
Our bodies are mostly water, so it is vital that we keep properly hydrated. According to a review study (albeit funded by the bottled water industry) there is evidence that not drinking enough may be associated with falls and fractures, heat stroke, heart disease, lung disorders, kidney disease, kidney stones, bladder and colon cancer, urinary tract infections, constipation, dry mouth, cavities, decreased immune function and cataract formation (Jéquier and Constant, 2010). Here are some tips to maintain proper hydration
I drink about 2.5 litres of liquid in an average day, about 1.5 litres is water and 1 litre is black tea and herbal teas. I drink a glass of red wine 3-5 times per week.
Eating is, of course, essential but it is nonetheless a stressor. This is evidenced by the fact that a large proportion of our immune system is contained in our digestive tract. Fasting can help to improve immune system function for a number of reasons including the following: inflammation of the digestive tract is reduced due to elimination of allergenic food (Salloum, 1999); normalised blood sugar levels, and enhanced immune cell activity (Hiramoto et al., 2008).
Julie and I do regular short fasts of 18-24 hours, and quarterly 5-day fasts. While we are enthusiastic devotees of fasting, it cannot be overstated that for optimal benefits fasting must be part of a lifestyle that includes a healthy diet. Without this combination, we are prone to falling in the “detoxification trap” – indulging in periodic cleanouts, only to return to a toxic lifestyle. Such an approaches is akin to yo-yo dieting, high intensity exercise in an otherwise sedentary life, and the superfood and junk food combo outlined above.
2. Frequent Movement
The oft-repeated mantra for good health – “eat less and exercise more” is quantitatively correct, but tells you nothing about the quality of what you are putting in your mouth, nor what you should be doing in terms of exercise. I prefer to focus on the word “movement” which encompasses both formal exercise and other types of movement. Paying attention to exercise alone may imply that all your body needs is short bursts of activity to offset long periods of sloth.
Unsurprisingly, researchers have found that the energy used in non-exercise activities dwarf the energy used in formal exercise for the vast majority of people (Shook, 2016).
A focus on movement encourages us to consider the importance of all of the physical activities we do throughout the day. Aboriginal people never formerly exercise but they are tremendously physically fit. Without the accoutrements of civilisation such as cars, dishwashers and home shopping delivery, aboriginal people, of necessity, have developed a daily movement regime in nature involving activities that are aerobic (talking pace), anaerobic (getting out of breath), mobility-related, and involve lifting heavy weights. We need to engineer a similar regime but one that is compatible with modern life.
That’s where OTMs (“Opportunities to move”) come in (Segar, 2015). What you focus on expands and awareness of the value of OTMs alerts us to the daily decisions that we (normally unconsciously) make about whether or not to move and how. Should I cycle or drive to work? Should I impersonate a circling vulture and always look for the closest parking spot or park further away? How can I reach for an object in a way that improves my range of movement? should I do yoga poses while the kettle is boiling, or should I slouch on the couch? Should I fidget at my desk or stay immobile? etc., etc.
But labour saving devices do exist and most of us are unlikely to embrace aboriginal living, so OTMs though necessary, may not be sufficient to maximise, strength, stamina, speed and flexibility; so most people need to do some formal exercise. The fact is that the best exercise for you is the exercise you will actually do, but here I want to single out the value of weight training in particular.
A great many people, especially women, are reluctant to use heavy weights (defined as a load that is close to your maximum) because they don’t want to “look like Arnold Schwarzenegger”. This is not a risk for most of us, men or women. Arnie and his ilk are “genetically gifted”, and spend hours working out. What I am advocating is within the reach of ordinary people.
Weightlifting helps to build bone density which decreases as you age. The higher the bone density, the less risk there is for fractures from falls. Fractures are a major cause of incapacity for the elderly and they are correlated with vulnerability to a range of morbidities. Weightlifting also improves flexibility as well as strength, so if you fall you have a better chance of breaking that fall and not fracturing. Weightlifting also helps to generate mitochondria – the body’s battery packs. More mitochondria equates to improved cardiovascular fitness.
The great news is that you can get the benefits of a strength-based conditioning from weight training for less than an hour a week using methods pioneered by Doug McGuff and John Little (McGuff and Little, 2009).
Exercise is a classic example of hormesis, or “good stress” – something that challenges the body which over-compensates and gets stronger (Mattson, 2008). A hormetic response is induced by pushing the body outside its comfort zone just enough. However, too much stress can overstretch the body’s capacity resulting in long-term breakdown.
The relationship between exercise and immune system function appears to be subject to a j-shaped curve indicative of hormesis or the “Goldilocks effect” – not too much, not too little, but just right. So, engaging in moderate activity may enhance immune function above sedentary levels, while excessive amounts of prolonged, high-intensity exercise may impair immune function (Gleeson, 2007). The definition of “moderate” or “excessive” will vary according to the individual.
Getting out in nature
There is sound scientific evidence to support something that we have known intuitively all along – that getting out in nature is good for our health. Japanese scientists have studied the effect of “forest bathing” (visits to a forest for relaxation and recreation) on immune function compared to the equivalent activity levels in a city location (Li et al., 2008). The investigators found that the forest bathers exhibited a significant rise in immune cell number and function and a significantly decreased concentrations of adrenaline. In contrast, the “city bathers” showed no changes. The changes have been partly attributed to phytoncides (wood essential oils), released from trees. Phytoncides were detected in forest air, but there were only trace levels in the city.
My movement regime is daily OTMs with lots of fidgeting, daily 1-2 walks with the dogs, 20 minute weights sessions twice per week, 1-3 cycles at below aerobic threshold (roughly defined as "talking pace") per week, and ad hoc 10-20 minute yoga sessions. The exercise component of my movement regime takes an average of one hour per day.
3. Sound Sleep
The invention of artificial light and a number of other developments have wreaked havoc on our sleep patterns. Most adults need 7-9 hours’ sleep per day but the average Briton gets only about six and a half hours (The Sleep Council, 2013). This is a huge issue and the importance of sound sleep for optimal health cannot be overstated. Specifically, there is a lot of peer reviewed literature demonstrating that sleep has a powerful effect on your immune response to viruses (Besedovsky et al., 2012; Cohen et al., 2009; Dimitrov et al., 2019).
Peoples’ sleep-related issues can be complex, and some people will need individualised support, but the following basic sleep hygiene tips can help in many cases:
I sleep 7 to 8 hours most days and go to bed at about ten o'clock most evenings. We follow the sleep hygiene tips outlined above, but do not always keep to the screen curfew before bedtime. However, if we do watch TV close to bedtime, we will be wearing our funky yellow-tinted specs which block blue (‘daytime’) light – it’s one of life’s little compromises.
4. Effective Breathing
It is estimated that we take more than seventeen thousand breaths a day, usually without even being aware of a single one. Becoming more aware of our breathing and harnessing this awareness on a regular basis can be immensely therapeutic. There are endless breathing techniques, notably from the yogic tradition, but here I will focus on three easy to learn practices that can help us to step back from life’s daily dramas.
Sixteen Seconds to Bliss
This simple technique can be used anywhere, anytime and anyplace and is a great instant stress reliever (Davidji, 2017). It comprises of one or more rounds of breathing in for a count of four, holding your breath for a count of four, breathing out for a count of four, and holding your breath for a count of four. Repeat as necessary.
For more details, see my article: Cultivating Stillness: Control, Alt, Delete for your Bodymind.
Developed in Russia by Prof. Konstantin Buteyko, the Buteyko Method comprises of reduced-volume breathing and breath holding. It has been shown to be effective for the management of asthma, with people able to substantially reduce medication with no deterioration in their asthma control, although no studies have demonstrated objective changes in lung function (Rosalba, 2008). The technique emphasises nasal breathing which is is likely to increase nitric oxide (NO) levels. NO influences many physiological processes including bronchodilation, vasodilatation, tissue permeability, immune response, oxygen transport, neurotransmission, insulin sensitivity, memory, mood, and learning.
For a practical demonstration of Buteyko breathing, check out the video below.
The Wim Hof Method
This system has been developed by the eponymous Wim “the Iceman” Hof – a Dutch eccentric with the look of a leprechaun, the enthusiasm of a young child, and the delivery of a stand-up comedian. His achievements include setting world records for the length of time for swimming under ice, and the fastest half-marathon ran barefoot on ice and snow. He has reached the top of Mount Kilimanjaro in two days wearing only shorts and shoes, and he ran a full marathon in the searing heat of the Namib Desert without water – thus proving his resilience at both ends of the thermometer. A wee word of warning: Wim Hof has been doing this stuff for many years. I am recounting his feats as a testimony to the power of the body-mind, not as an encouragement to others to attempt to emulate or surpass Wim, unless they build up gradually and have full medical backup.
The Wim Hof Method (WHM) comprises of three pillars: breathing, cold exposure and meditation. Here we focus on “Wim Hof breathing”. Drawing heavily on yoga practices, notably Tummo or Chandali Yoga, Wim Hof breathing comprises of cycles of hyperventilation followed by breath holding (hypoventilation) which helps us to resist the cold (Carney and Hof, 2017). The method has been subject to scientific scrutiny in which the investigators found that trained group were better able to fight off infection than an untrained control group (Kox et al., 2014). The essence of the method is very simple to learn from the free miniclass available on Wim Hof’s website.
Before exercising I use Wim Hof’s 11 minute guided breathing session (from the video below) as a way to increase my energy levels. For the rest of my day I use nasal breathing with periodic Buteyko exercises and sixteen second breaths as necessary.
5. Psycho-Social Health
There are many kinds of stress, but they all boil down to physical, chemical, or psychosocial stimuli that are present in too high a dose, too low a dose, or are stimuli that are too new for the body-mind to absorb. Novel compounds such as synthetic pesticides and plastics come into this category as do substances such as mercury and asbestos, which occur naturally but to which we would not have been regularly exposed during our evolutionary history. The body is constantly subjected to stresses, for example, air and water pollutants, potentially stressful events, processed foods, and electromagnetic radiation. But we have mechanisms to deal with stresses/toxins including a well-functioning immune system. The capacity of the body to deal with stresses/toxins can be compared with a bucket. As long as there is capacity in the bucket the body does not become diseased, but if there is more stress/toxicity than the bucket can hold a disease will emerge. Disease emerges once a threshold is crossed.
In common parlance, people use the term stress to refer to psychosocial stress - anything that translates into a perceived threat to our social status, social esteem, respect, and/or acceptance within a group; threat to our self-worth; or a threat that we feel we have no control over. There is a plethora of literature on the effects of psychosocial stress on the immune system and its effects on a diverse range of chronic and infectious disease processes and outcomes (Campos-Rodríguez et al., 2013).
Rather than attempting to summarise the vast literature, I will outline some simple practices that can help to manage psychosocial stress – a daily gratitude practice, Emotional Freedom Techniques (EFT or Tapping) and mediation. One valuable stress management modality - mindful breathing is summarised above.
A daily gratitude practice
Humans are hard-wired to pay attention to threats. This has had survival value for much of our existence as a species, and it still has to some extent. In ancient times it would not have been to your benefit to admire the graceful feline form of sabretooth tiger which sought you out for its supper. Rather, you needed to focus on its bad intentions and turn tail as fast as possible, or hurl a spear into the space between its eyeballs. And in modern times, the best attitude to that unexpected email with news of your inheritance from your lost late uncle Eustice is to distrust and delete rather than trust and transact. So “negativity” is necessary, but it can lead to chronic stress if it perpetually casts a shadow over the positive side of the coin.
There is a great deal of evidence that a daily gratitude practice has powerful physical and psychological benefits (Emmons, 2008). And, the more we focus on what we are grateful for the more we find things to be grateful for. What you focus on expands.
Julie and I have a simple morning and evening gratitude practice in which we alternately state three things that we are grateful for. They can be large things such as the beautiful planet on which we live, or everyday experiences such as having a nice walk with dogs.
Despite its apparent simplicity, it is possible to mess up a gratitude practice and I speak from experience. When we started the ritual in April 2013, I only focused on overtly positive things but steered clear of the silver linings that hide in every cloud. This engendered denial and frustration. I write about this experience in the article How I messed up my daily gratitude practice - Walking the tightrope between expressing appreciation and kidding ourselves.
Emotional Freedom Techniques (EFT or Tapping)
Thanks to my wife Julie, who is a Certified EFT Practitioner, I learned the basics of tapping and, have been using EFT for some time when I felt emotional blockages, large or small. Tapping your fingers on acupuncture points on the face and body calms the amygdala (the part of your brain that triggers your fight or flight response) and helps energy to flow freely throughout the body. Tapping has been shown to provide effective relief for a myriad of issues such as anxiety, depression, obesity, high blood pressure and chronic pain.
The classic EFT process involves tapping nine acupuncture points in turn and saying (aloud or to yourself) “even though I have this problem” [insert problem here], “I love and accept myself.” Following this ‘set up statement’, you come to name the problem, explore its root cause and find your own solutions while you are in a resourceful state, rather than sitting or lying passively. Tapping can be done on your own, but it is better to work with a qualified therapist if you are a beginner or have complex issues to deal with. Tapping is easier to conceive of when watched rather than read about so I recommend that you consult the short YouTube video linked to below for a clearer idea of what it is all about and how to do it.
Meditation has moved from the margins to the mainstream in recent years. Like breathing practices, there are diverse approaches to meditation. Many of us who have been brought up in the west struggle with meditation. This is not surprising given the nature of our upbringings with a focus on logic and the material world. I am by no means a meditation master but find the following technique I call decoupling your trains of thought to be useful. This technique was introduced to me by Neuro-linguistic programming (NLP) expert, life coach and “head fixer” Ali Campbell. I call it Decoupling Runaway Trains of Thought.
Ali describes this form of meditation “for people who suck at enlightenment!” as the single most powerful exercise he has done to improve his life. That statement certainly made me sit up and listen as it comes from a man who has a deep understanding of a rich smorgasbord of life-changing techniques. Below is a summary of this simple but very powerful exercise.
When you first start doing this you will probably find that the thoughts come thick and fast. Ali Campbell likens it to a dam bursting and unleashing a torrent of thoughts. But over time you will find that the thoughts flow more slowly, as if you are sitting by a riverbank observing the thoughts gently flowing by.
In addition to our daily morning and evening gratitude practices, Julie and I meditate every morning for about ten minutes.
6. A Healthy Environment
Nobody lives in a vacuum and we are all influenced by the environment in which we live. So the link between environment and health should be self-evident, yet it is often ignored. In this section I introduce the topic of toxins found in our indoor and outdoor environment and explore the benefits of hot and cold exposure for the immune system.
Many a substance has followed a familiar journey from being labelled as harmless to being declared to be toxic, via what I have named “The Schopenhauer Sequence”, after Arthur Schopenhauer’s famous quote on the nature of truth. The sequence from ridiculous to self-evident via opposition has been repeated time and again for a long and growing list of substances, which have transitioned from apparently benign to being banned, restricted, heavily taxed, or plastered in health warnings. Substances that have completed the sequence include lead, asbestos, DDT, PCBs, BPA, and of course tobacco. Some are in still in the violently opposed state. These include mercury in dentistry; aluminium in cookware, antacids, antiperspirant and vaccines; and glyphosate in pretty much everything we eat and drink (Myers et al., 2016). Currently in the ridicule stage, with a mix of violent opposition thrown in for good measure, is electro-magnetic radiation, in particular 5G (Davis, 2019).
The above discussion refers to individual substances, but in the real world pollutants are likely to act synergistically, but synergies are almost never tested for. With hundreds of new chemicals being added to the environment every year, this testing gap is to be expected.
In the absence of adequate testing, examination of synergies, and long term monitoring, we are all unwitting participants in an uncontrolled natural experiment. Because so much stuff is being introduced at once it is very difficult to unravel cause and effect. In such circumstances I rely upon the precautionary principle – “guilty until proven innocent”. The precautionary principle states that when human activities may lead to unacceptable harm to humans or the environment that is scientifically plausible but uncertain, actions shall be taken to avoid or diminish that harm. What this means for me in practical terms is that I will let the Schopenhauer Sequence play out, but in the meantime, I will use natural personal care and cleaning products, filter my drinking and washing water, eat organic food as far as possible, and use a wired Internet connection.
Hot and cold
As discussed earlier, we can tolerate a bit of toxicity and according to the toxic bucket or total load model of disease, disease emerges when our exposure to toxins exceeds our ability to mitigate this exposure. The lifestyle strategies outlined in this article are designed both to minimise exposure and to mitigate toxicity, a central component of which is optimising our immune system.
For centuries, hot and cold treatments have been advocated for health, hygiene, social, and spiritual purposes. The potential for health benefits of heat and cold is congruent with the principle of hormesis. One of the most studied modalities is sauna bathing (Hussain and Cohen, 2018). Numerous beneficial effects have been suggested, including a reduction in the risk of developing certain chronic or acute respiratory illnesses (Kunutsor et al., 2017).
Another simple hot-cold treatment is a contrast shower in which you flip between hot and cold. A hot to cold shower is one of the pillars of the Wim Hof Method. Most people will be able to gradually adapt to longer periods of cold, but anybody with heart disease should exercise caution regarding cold exposure. It is advisable for this group to consult their doctor if contemplating cold baths, open water swims in winter, contrast showers or similar practices.
I meditate in our homemade near infrared sauna for about ten minutes every day and have a contrast shower of two sets of one-minute hot, one-minute cold. I know it could be a bit longer, but I don’t want to waste water!
7. Personal Empowerment
The healthy living approach we promote at New Paradigm Health is one that is based on personal empowerment – where each individual develops their own set of lifestyle practices that facilitate optimal health in a manner that is congruent with their unique nature and circumstances. These practices must be based on an understanding of their fundamental human needs and a knowledge of where their personal power lies. Without these foundations, people are prone to be blown off course by events, trends and the well-intentioned and sometimes not so well intentioned opinions and advice of others.
Identifying your fundamental human needs
Tony Robbins’ six human needs framework provides a simple, powerful and intuitive framework for assessing our dispositions. I have used this framework to understand my own aptitudes and those of the people I work with as part of a strengths-based approach to personal and organisational development.
Tony Robbins has built on the work of John Burton and Abraham Maslow to develop human needs psychology. In essence, Robbins believes that everybody’s actions are driven by the need to fulfil one or more of six basic human needs. By definition, these are needs that we all share, but everybody is unique, so we do not value all our needs equally. Different people will emphasise different needs and this emphasis often shifts as we go through life.
The six fundamental human needs are as follows:
I unpack these each of these needs in my article - Why we Think and Act the Way we Do: The Six Fundamental Human Needs as the Basis for our Unique Dispositions.
Understanding our human needs helps us to know which needs we habitually meet, which needs are not being met, which needs we want more of, and conflicts and trade-offs between meeting some needs at the expense of others. This understanding also helps us in our relationships of all kinds as we become less judgemental by acquiring a fuller understanding of the factors that motivate other people’s aptitudes, attitudes and actions.
You can assess your human needs with this online test devised by Chloe Madanes who has worked extensively with Tony Robbins to advance the thinking in the field. The results include detailed information on how your primary need and top two needs can serve you or hold you back.
Knowing where your personal power lies
I love the Serenity Prayer – or at least the three lines which I know, as made famous by Alcoholics Anonymous:
Grant me the serenity to accept the things I cannot change
The courage to change the things I can
And the wisdom to know the difference
In terms of understanding your place in the world, it is critical to know what circumstances are under your control, what circumstances you can directly influence, and what circumstances you can neither control or influence despite the fact that they are cause for concern.
This model can be visualised in terms of circles of control influence and interest. Only one person stands in the circle of control – yourself. However, you do have some influence on others with whom you interact, just as they have influence on you. Finally, there are others whom you cannot directly influence whose actions may give you cause for concern. This is a concept used in the Outcome Mapping system for project planning, monitoring and evaluation – a system I find very useful and use extensively in my work.
In terms of living in alignment with your values, it is advisable to place most effort in the spheres of control and influence where you are best placed to make a difference. Of course, as is clear from its name, you are still interested in the sphere of interest/concern, but your ability to directly affect change in this sphere, at least in the short term, is limited.
Knowing where you stand helps to provide you with the certainty you need to face life’s challenges regardless of how much influence you may or may not have on others and in the face of concern about a world that does align with your deepest held values. Most people do not have the power to reverse the endless stream of doom and gloom that is the 24-hour news media, nor to affect entrenched power structures in the immediate term; but they do have considerable power over what they put in and on their bodies, what they put their bodies into, and what they put their bodies through. Being the change you want to see in the world is powerful and helps to displace fear with focus.