COVID-19 coronavirus - an athlete’s perspective

Blog post by Ian Craig,

This blog post is based on another article that I wrote for my clients last week, attempting to bring a voice of reason within a storm of fear about this rouge virus. The best thing we can do right now as practitioners is reassure our clients and help educate them about how to support their immunity – and that statement applies for athletes and lay people.

Within this article, I introduce the context of sport, and I wish to start my discussion with the following image of a J-shaped curve, which was conceptualised by Professor David Nieman in 1994. As a young athlete going through puberty and growing into my very long body (6’3”), I experienced a lot of throat infections, which seemed to plague me for a few winters.

By the time I started studying exercise physiology at university, I was extremely interested in the exercise immunology space. In 1995, while studying for my Masters degree in North Carolina, I was fortunate to meet David Nieman, a guest lecturer from Appalachian State University. He presented data, particularly from marathon and ultra-marathon races, which demonstrated a very high risk of upper respiratory tract infections (URTIs) when athletes were pushing their bodies to the limit. Some 25 years later, I have seen nothing to truly challenge his hypothesis, which basically said that sedentary and very high volumes and/or intensities of exercise compromised the immune response. Moderate activity, on the other hand, is thought to support immune health.

J shape 

Unlike my very early intention to specialise in exercise immunology, I have now become a health and performance ‘generalist’ because I prefer to understand the big picture of physiology and how all parts relate to and influence one another. I therefore don’t have a in-depth knowledge of B-cells and T-cells and how they respond to invading pathogens, but I do have an excellent understanding of the lifestyle factors that inhibit or support immunity, especially in an athletic setting.

The inverted-U model or J-shaped curve, as presented by Professor Nieman, has been challenged over the years, but the reason I don’t think anyone will ever prove this hypothesis wrong is because it makes logical and intuitive sense, coupled with a bit of historical observation.

The ‘germ’ and the ‘terrain’

If we backtrack 200 years, as discussed in Robin Needes’s excellent book You Don’t Have to Feel Unwell!, we had two prominent French medical scientists, named Pierre Béchamp and Louis Pasteur around this time. Béchamp was actually the first person to discover airborne microbes and he went on to understand that healthy cells contained living organisms, that could evolve into bacteria, but only under unhealthy conditions. He therefore considered these organisms (in each and every one of our cells) to be a basic requirement of life, noting that disruption of them could lead to disease. Later on, another medical personality from the time, Bernard, described the actual environment that affected these changes in health, including how the nature of the microorganisms change as the body moves from an alkaline to an acidic pH.

As the story goes, Louis Pasteur stole Béchamp’s work, and to this day the common belief is that he was the person to discover airborne microbes. He is also often wrongly credited as the person who identified penicillin as an effective antibiotic treatment. Also, unlike Béchamp, he did not proceed further to try and understand the relationship between the germ and the body (which they called the ‘terrain’), and theorised that all disease was caused by these microbes. Because he was a better marketer than Béchamp and Bernard, his viewpoint prevailed during these times, and unfortunately still does today within standard medical practices – obviously this belief has been propagated by the pharmaceutical industry, who sell an awful lot of antibiotics every year. To finish this story of historical rivalry, which is very much mirrored by what is happening in orthodox medicine today, apparently Louis Pasteur said on his death bed: “Bernard was right; the terrain is everything, the germ is nothing.”

So, why bore you with this very old story? Within integrative practices, such as nutritional therapy, naturopathy, functional and integrative medicine, homeopathy, plus many others, we focus on the body’s own immune system as absolute priority in any health case. How this historical reflection relates back to the athlete is that the ‘terrain’ is either nurtured or compromised by what we do to it every day. High-level training, or even moderate-level training by an individual with a high life load, puts stress on the athlete’s immune system, and therefore inhibits its ability to defend itself again foreign microorganisms. That is why athletes who travel overseas, in particular, are at a significantly increased risk of infection; they are exposed to unfamiliar germs that their immune system has not yet developed the antibodies for. If our body is healthy, and otherwise well-resourced, it can develop an immune defence relatively quickly. However, if hard-working skeletal and cardiovascular muscles have competed for the energy and nutrients required for immune health, as in the case of an athlete who is balancing on the knife edge between health and illness, it takes much longer to raise the immune defence. This means: a) they are more likely to become ill, and b) take much longer to fight off the infection – something I found to my frustration as a teenager, still trying to fulfil my weekly mileage log as my body fought for nutrients to grow.  

The COVID-19 virus

According to data from the World Health Organization (WHO), the new COVID-19 strain of coronavirus produces the symptoms of a dry cough and fever in most recipients, and fatigue and/or sputum production in around a third of cases, plus a number of less common symptoms. The incubation period, based on the patients studied in China, can vary between 1 and 14 days, and the period from onset until clinical recovery is about two weeks in mild cases, and three to six weeks in critical cases. Again, according to WHO, about 80 per cent of all reported cases have been mild in physical impact and 2.3 per cent have died from the infection. However, they also acknowledged that the true total number of cases is likely much higher than the number of confirmed cases, which would dilute the number of severe cases substantially.

Looking again at the WHO statistics, there are two main factors that predispose a fatal outcome from COVID-19:

  • • Being over 70 in age, although it is actually the over 80s who are more at risk.
  • • Having an underlying health condition: i.e. already being immune-compromised. People who already have cardiovascular disease, diabetes, chronic respiratory disease, hypertension and cancer are substantially more at risk.

In summary, a young fit and healthy athlete should not need to worry about a serious outcome from exposure to this virus – in fact, most young adults in their 20s, who have tested positive for COVID-19, kicked the virus into touch very rapidly. However, in relation to the J-shaped curve above, I am concerned about athletes who are really pushing their limits and deeply suppressing their immune defences. Our adaptive immune systems are required to build up antibodies against this pathogen before it can properly eradicate it. If our nutrients and energy are displaced for training purposes at the time of exposure, the risk is that the virus has more opportunity to ‘take hold’ in these athletes’ immune systems. It therefore takes much longer to remove it and get over the infection, resulting in a valuable loss of training time.

Additionally, I am concerned about masters athletes who have been pushing the boat out for many years in terms of their training volume and intensities. I wrote an article on cardiovascular (CV) health in sports in the Jan/Feb 2020 issue of Functional Sports Nutrition magazine. I uncovered some scary research that was pointing to a much higher-than-average incidence of cardiovascular pathology in long-term serious athletes (compared to age-matched control subjects). Myocardial scarring, elevated levels of coronary artery calcium, atherosclerotic plaques and atrial fibrillation were some of the pathology markers measured. As I’ve just noted in my reference to the WHO statistics, individuals with CV pathology are at a higher risk of mortality if they contract the COVID-19 coronaviral strain.

The message here is to pull back in your training volume and intensity during this period of time. Many of us can’t leave our house, but don’t be tempted by the treadmill or by engaging in some hectic training because you have cabin fever. I heard a report of a Frenchman who recently ran a marathon distance on his 7-meter apartment balcony… Respect? Not from me!

Let’s rather use this time as a period of introspection: what can we do, and in what way can we educate our clients, to greater levels of health as time goes on?

How do we support our immune system?

If you’ve followed me so far, you’ll hopefully appreciate the dose-dependent relationship between training levels and immune health – let’s now expand to other strategies that are important for immune support.

First and foremost, our immune system is dependent on many nutrients, which are best found in our food, although supplementation is also a sensible step. Here is a list of some important ones and where to find them:

  • • Vitamin C – one of the most important immune-system boosters. It is found in good quantities in oranges, grapefruits, tangerines, strawberries, bell peppers, spinach, kale and broccoli.
  • • Vitamin D – vitally important for regulation and balance of the immune system. It is found in fish, dairy, eggs, shiitake mushrooms and, of course, sun exposure.
  • • Vitamin E – an antioxidant that protects the immune system. It is found in seeds, nuts, avocado, spinach, and other leafy greens.
  • • Selenium – plays a vital role in the glutathione antioxidant system in our body. It is found in good quantities in fish, poultry, red meat and Brazil nuts.
  • • Zinc – important for enzymes within the immune system for biochemical processes to proceed. It is found in nuts, seeds, quinoa, lentils, fish, poultry and red meat.

Herbs can also have a very powerful effect on our immune system. For example, my ‘go-to’ concoction for immune support is vitamin C, zinc and echinacea. In terms of viral protection, I would also strongly recommend andrographis and cat’s claw. If you are concerned about your own immune strength, or that of your clients, one of the best things you can do is consult a herbalist or homeopath who can put together a bespoke blend of herbs and/or homeopathic remedies for you.

Here are some more general tips for immune support:

  • • Avoid excessive sugar, caffeine and alcohol in your diet
  • • Minimise your chemical exposure, including toiletries and cleaning products. Ironically, the harsh sanitisers now in use can negatively influence the mucosal membranes in our lungs, so use at your own discretion
  • • Avoid excessive volumes and intensities of exercise, which this article has centred around
  • • Likewise, don’t work too hard at this time - if you set up your work from home in an efficient way, you can have more time for recuperation
  • • Minimise processed foods – stay as fresh as possible, so if you’ve stockpiled tins, leave them in the cupboard until you absolutely need to rely on them
  • • Breathe well – this is a great time for yoga, Tai Chi, meditation and mindfulness, all shown to improve immune strength

I can’t finish without mention of the ’S’ word. Stress is associated with the hormones adrenaline and cortisol. In the short term, adrenal hormones can actually prop up our immune response, but over the long term, stress can be highly destructive to our immune response and that is one key reason, in my mind, for the massive increase in the incidence of autoimmune conditions nowadays.

According to Patricia Worby from Alchemy Therapies in the UK; “stress and unresolved emotions can totally hijack your immunity by triggering a chronic stress response in the survival part of your brain and this can get stuck in your body.” She advocated that we avoid dramatic newsfeeds and look to credible sources of information about COVID-19, including WHO and the Harvard Medical School.

And that is how I would like to end this rather long blog post. My intention of writing it was to introduce or reinforce the dose-dependent relationship between health-supporting strategies and our immune health, and that of our clients. I am using the word perspective more and more in my writing because it reflects the bigger picture of health and performance contributors. There is no point in understanding the innate and adaptive immune responses in incredible academic detail if, for example, you don’t appreciate the negative influence of heavy training and processed foods. The practical day-to-day interventions, expressed in simple terms, are what your clients are going to understand and put into action with ease. 

For more information on COVID-19 view: Our World in Data.