What’s the Problem, Dr. Korman?
by Laura Korman, DC
Q: What can I do to strengthen my immune system?
A: year and a half ago, I was answering many patient questions about how to prevent heart disease, diabetes or cognitive decline. But today, their concerns are predominately centered around another question: how to improve their immune health.
My answer is that the same foundational principles apply, whether your goal is to prevent a chronic illness or an acute infection. It has been shown that having a chronic illness, such as obesity, hypertension, heart disease or diabetes, weakens immune resistance and puts you at a much greater risk for negative outcomes from COVID-19.
Whether you are vaccinated or not, metabolic health should be the top priority. Therefore, my advice starts with improving metabolic health which I believe is under-emphasized, and even ignored, by healthcare leaders as a first-line defense against the COVID-19 virus.
According to the CDC, 73.6% of American adults are overweight with a Body Mass Index (BMI) over 25, and 42.5%, are now obese with a Body Mass Index or over 30. Childhood obesity is also on the rise, affecting nearly one in five children between the ages of two and 19. This puts them at serious risk for a lifetime of poor health. In fact, obesity is the primary driver of heart disease, diabetes, and some forms of dementia and cancers.1
In addition, a recent study of COVID-19 cases suggests that risks of hospitalization, intensive care unit admission, invasive mechanical ventilation and even death are higher in those with an increasing BMI. The increased risk for hospitalization or death was particularly pronounced in those under the age of 65.
More than 900,000 adult COVID-19 hospitalizations occurred in the United States between the start of this pandemic and November 18, 2020. Models estimate that 271,800 (30.2%) of these hospitalizations were attributed to obesity. Even more alarming, most people who are hospitalized with COVID-19 have more than one disease (comorbidity).2
Another study looked at 5,700 patients in New York City and found that 88% of them had more than one chronic condition. Only 6.3% had just one underlying condition, and 6.1% had no other coexisting conditions.3 The most common thread connecting these comorbidities is insulin resistance which is at the root of poor metabolic and immune health. This occurs when people consistently consume foods that raise blood sugar levels beyond what the body is burning or requires for energy. This excess blood glucose, stimulates higher levels of insulin which, over time causes, the cells to become less and less responsive to the effects of insulin.
Insulin is there to drive blood sugar from food that was just consumed into the cells, both for immediate energy needs and to store it as fat for later energy reserves. Insulin resistance is also known as metabolic syndrome or pre-diabetes, and is the metabolic dysfunction of Type-2 Diabetes. It is estimated that 40% of Americans have pre-diabetes, and most of these individuals do not even realize it.
The first recommendation I have for a patient who wants to strengthen immune health is to lower their BMI if it is above 25—which is the case for nearly three out of four adults. Then, order a HgA1c test along with a fasting insulin test. Optimal functional levels should be below 5.7ng/mL and 5.0ng/mL., respectively.
I also instruct my patients to avoid foods that elevate blood glucose and insulin levels like sugary foods and beverages, processed carbohydrates, pre-packaged and fast foods. Sugar directly lowers the white blood cell defense against pathogens. Shop for whole, limited ingredient foods (found primarily around the perimeter of the grocery store) and focus on organic, non-GMO, pasture raised and local sources if possible. Avoid inflammatory vegetable and seed oils like canola, soybean, corn, sunflower and safflower oils (found in most dressings and condiments). Extra virgin olive oil and avocado oils are preferred.
My second recommendation is that patients have their serum vitamin D levels checked, as there is overwhelming evidence of the correlation between low vitamin D levels and poor COVID-19 outcomes. Optimizing vitamin D could be the easiest and single most important strategy to minimize the risk of COVID-19. I advise my patients to take enough vitamin D3 to keep their serum levels optimally between 60-80 ng/mL. Vitamin K2 should also be taken with vitamin D3 as these two vital nutrients work together to help absorb and divert calcium into the bones and away from the arteries.
Other supplements that have been shown to improve immune function are vitamin C, zinc, quercitin, (which helps zinc work better) and N-acetylcysteine (NAC) which helps to increase glutathione levels. Glutathione deficiency is associated with more severe COVID-19 outcomes. In addition, glutathione could also help prevent harmful cytokine storms and the formation of blood clots.
Finally, I emphasize the importance of regular exercise, stress management and adequate sleep when trying to optimize immune health. The goal should be 20–30 minutes of gentle aerobic exercise, preferably outside, to help lower blood sugar and insulin levels. This can be especially effective following a meal.
Exercise also decreases stress hormones and improves oxygenation and lung function. Stress is at an all-time high and negatively impacts the body’s resistance to infection. We need to make quiet time, prayer, meditation or exposure to nature daily priorities—even if just for a few minutes—to be mindful, present and grateful. This will shift the nervous system from a fight-or flight state to a rest-and-digest state. This will help the stress hormones to become more balanced, digestion to improve and blood pressure to normalize.
Unmanaged stress can also affect the quality of sleep. One restless or insufficient night of sleep can increase insulin resistance and blood sugar levels the following day. My advice to improve sleep is to set a bedtime for later than 11:00 p.m. (preferably earlier) to achieve seven or eight hours of quality sleep in a completely dark room, void of electronics and cooled to about 70 degrees. Avoid eating three hours before bedtime, and discontinue the use of LED screens an hour before bedtime.
Eating too close to bedtime puts stress on the liver and the digestive system which decreases the body's potential to rest and recover. LED lights can also block the body's production of melatonin which is essential for initiating sleep.
It is my hope that the information I shared about our nation’s state of poor metabolic health is not only a wake-up call but also a call to action. While we might not always have control over outside forces or environmental influences that surround us, we do have the power to make personal decisions to move more frequently, eat healthier, sleep better and manage stress more effectively. These simple and sustainable lifestyle strategies would make a huge impact on improving both metabolic and immune health on an individual and goal scale.
If you want additional help improving your own metabolic health, please reach visit my website at DrLauraKorman.com for more information.
Adult Obesity Facts/Overweight & Obesity, CDC.gov
Obesity, Race/Ethnicity and COVID-19, Overweight & Obesity, CDC
Maaike van Gerwin, et al., J Med Virol., 2021 Feb.