Why Are Elderly More Susceptible to COVID-19?

by Dr. Iva Lloyd, ND

Over 80% of deaths due to COVID-19 have been in those over the age of 70. Although there is some variability based on country, the fatality rate for those in their 40's is about 0.4% and it is just over 1% for those in the 50's.  The fatality rate jumps to about 8% for those in their 70's that contract COVID-19 and can be as high as 15% for those over 80 years of age that have the virus. Those of any age that have co-morbidities and are in institutions are the greatest risk.

As we have seen, people of all ages contract COVID-19.  Most people experience no symptoms or mild symptoms that don't require hospitalization or medical treatment. When we see the tremendous impact that COVID-19 is having on the elderly it is imperative to delve into this situation in more detail and to understand the various factors that are contributing to this situation.  We have all unfortunately heard of the issues around the management of some old-age homes, this blog focuses on other factors that contribute including age itself, co-morbidities, nutrient deficiencies, lack of movement, stress and isolation and air quality.

Understanding why the elderly are more susceptible to dying from COVID-19 is a complex problem that will require a multi-factorial approach on an ongoing basis.

Age Itself

As people age their ability to fight infections decreases.  Older people are generally not as good at reacting to microorganisms that they haven't encountered before. They have less immune chemicals to fight pathogens, such as viruses and their immune system is slower and less effective.  This gradual deterioration of the immune system is referred to as immunosenscence and there is a concern that older people who have survived COVID-19 may not have the same immune memory as younger people exposed to COVID-19 and may be at greater risk of contracting the virus again.

It is important to recognize the difference between chronological age and biological age.  Chronological age is your actual age based on date of birth.  Biological age is the accumulation of your genetics, lifestyle factors, health habits, accidents and conditions that you have encountered throughout your life.  Some people in their 70's and 80's are in better health and have more resiliency or vitality than people in their 50's that have poor lifestyle habits and chronic conditions that they are managing. When deciding if you or a loved one is at high risk, the biological age will be more accurate.

Nutrient Deficiencies

Research has shown that nutrient deficiencies are a global problem. The elderly and those that are institutionalized are more likely to be nutrient deficient.

Although nutrient deficiencies are more common with age, this is a problem as there are a number of nutrients that are required for the immune system to function properly.  Vitamin A, Vitamin C and Vitamin D, Omega 3 Fish Oil, Selenium, Zinc and Melatonin are all essential nutrients in immune function. When a person, of any age, is deficient in essential vitamins, minerals and nutrients, what we find is that the immune system is not able to efficiently handle a virus or pathogen that it encounters.

It is common for dietary habits to change with age.  If that change includes a decrease in fresh fruit and vegetables and lean protein then nutrient deficiencies will result. Immunosenescense and chronic inflammation are correlated with nutritional deficiencies.  Maintaining adequate nutritional levels throughout a person's lifetime, whether through diet or supplementation, is essential for optimal health.

Check out blog: Food and Immune Health .

Lack of Movement

Movement is required for every function in the body.  It promotes proper blood and lymphatic circulation which keeps the cells of the immune system functioning and moving.

Movement may actually help flush pathogens out of the lungs and the airways.  It also supports the role of white blood cells in fighting disease. Moderate movement is associated with immune health.  Walking 20 minutes a day, bicycling, swimming, playing golf and other gentle types of movement are best for immune health.

As COVID-19 is impacting the cell's ability to carry oxygen, it is not surprising that the elderly that are institutionalized and generally less active are more affected.  When active, be cautious about wearing a mask. Although the new trend is for people to wear masks often, they can actually be detrimental - especially if worn while exercising.  Here is some update information on the pros and cons of masks.

Check out our blog: Movement - Top 5 Things to Remember

Stress and Isolation

The connection between stress and a weakened or compromised immune system is well understood.  When a person is under a lot of stress the immune system's ability to fight off infections is reduced. For some people this time of isolation has been an opportunity to recoup and to catch up on sleep and and tasks around the home.  Some people have welcomed the opportunity to work from home and spend time with their family and loved ones.

For others, the COVID-19 pandemic has been an unyielding stressors.  For many elderly people the fact that they have not been able to socialize with their family and friends has been a tremendous physical and emotional burden. Seniors are also more likely to be institutionalized and isolated.

The impact of stress and isolation can not be overlooked.  How a society treats older adults plays a big role in their risk from diseases like COVID-19. Isolation worsens everything and the current situation is a stark reminder of the importance of reaching out to those that are alone to let them know that we are thinking of them and that we are here to help.

Co-morbidities

Irrespective of age, co-morbidities such as diabetes, hypertension, cardiovascular disease and obesity are associated with increased risk of COVID-19 affecting the health of those affected at any age, especially in the elderly.

A person's ability to handle an infection partly depends on how stressed the body is in dealing with other chronic diseases. It is also important to note that nutrient deficiencies, a sedentary lifestyle and excess stress are also correlated with increased risk of chronic diseases. It is not surprising that elderly have a greater chance of having one or more chronic disease.

Addressing any co-morbidities is an important part of health promotion and disease prevention.

Blog: Don't Wait Until You're Sick To Get Healthy
Blog: A Crash Course on Respiratory Health

Air Quality

Addressing the management of COVID-19 must include assessing air quality especially as most people that have been infected have contracted the virus while inside. COVID-19 is more likely to spread indoors with hospitals and institutions having been associated with the most infections other than family transmission while at home. Air quality in institutions, especially those with high rates of infected individuals, is important to assess and address.

There has been a tremendous focus on washing hands frequently and cleaning surfaces, but there is growing research that in order to control COVID-19 the focus must also include the role of indoor air on disease transmission and occupant health. When the indoor air is dry, human occupants are more vulnerable to viral respiratory infections. Dry air can impair respiratory immunity by drying out the nose, sinuses and throat thus lessening the ability of cilia, the hair-like projections on cells lining airways, to expel viral particles. Dry air also lessens the effectiveness of the skin, eyes and other mucous membranes that are there to protect us from infections.

Over the next few months expect to hear more about ways that companies are improving the air quality in offices, air planes are making it safer to travel by addressing the air quality in planes, hospitals are assessing air exchange and there will be numerous recommendations on how to have healthier air quality at home. I expect that there will be a competition on what type of building or plane has the best and worst air quality.

The growing focus on air quality should be a reminder of the importance of spending time outside, ideally in a park or area with trees. When outside, especially with exercising, consider not wearing a mask so that you and your lungs can take advantage of everything that nature has to offer.

It is important that we look at why elderly are more susceptible to COVID-19 from as many angles as possible. Going forward we need to be aware of the health promotion and disease prevention strategies for each of us, including the elderly.

Additional Symptoms of COVID-19

by Dr. Iva Lloyd, ND

A common question over the last month is whether or not a specific symptom could indicate COVID-19.  The focus of Public Health and the media has been on the three most common symptoms, that is tiredness, fever and cough.  Tiredness is the most common symptom with about 68% of people experiencing it, followed by 60% of people having a dry cough and 56% of people experiencing fever, especially in the early stages of COVID-19.

An interesting symptom that has received a lot of focus over the last few months is loss of smell.  There are a number of research articles that indicate that an early indicator of contracting COVID-19 appears to be anosmia, or loss of smell.  The loss of smell does not appear to be correlated with how severe the symptoms of COVID-19 will be as there are some individuals that only experience a loss of smell, whereas others have digestive and/or respiratory symptoms as well.  Some people experience an altered sense of taste which can be associated with the altered sense of smell.

There are a number of other symptoms that are commonly experienced in those that tested positive for COVID-19.  Digestive symptoms such as loss of appetite, diarrhea and nausea are common in 44% to 55% of individuals that tested positive.  Muscle and joint pain and headaches are also common in about 45% of individuals.

What Does This Mean?

Based on: https://jamanetwork.com/
journals/jama/fullarticle/2765183

Many of the symptoms associated with COVID-19 are common symptoms that people experience all the time.  The chart to the right highlights the frequency (by percentage) that the following symptoms were experienced in 202 individuals with mild to moderate symptoms (age range from 20-89 years with a median age of 56) that tested positive for COVID-19.  The results in this study were similar to those reported in a number of other studies from around the world.

A symptom that is not on the chart, but was the focus of the study was loss of smell and/or taste. The study found that 64% of those that tested positive also reported an altered sense of smell and/or taste.

The presence of any one symptom does not necessarily mean that you are dealing with COVID-19.  For example, many people commonly experience headaches, digestive issues or muscle pain and other symptoms on an ongoing basis.

Four Phases of COVID-19

There are four stages to COVID-19: prevention, infection, inflammation and recovery.  A person's ability to move through the four phases determines how sick they get and how long it takes them to recover, if infected.

1. Prevention.  Public health policy is primarily focused on the prevention phase with their recommendations for social distancing, washing hands, disinfecting surfaces and wearing masks when unwell or unable to social distance.  The naturopathic profession adds to this by emphasizing the importance of focusing on overall health and addressing lifestyle factors as a means of ensuring that you are equipped to handle life challenges, including viruses and other pathogens when you encounter them.  It is also important to work with your naturopathic doctor or other health professional if you have or suspect underlying health issues such as diabetes, cardiovascular disease, chronic inflammation, obesity, respiratory conditions or other lifestyle-related conditions that might impact your ability to heal.
2. Infection.  When someone feels that they have become infected it is important to get tested and to follow the recommendations given.  The chart above highlights the symptoms that may be associated with being infected.  If you do experience any of these symptoms and they are new to you or are accompanied with an overall sense of being unwell, it may be beneficial to get tested.
3. Inflammation.  The inflammatory phase is the one that appears to be the most concerning for COVID-19.  The fatality risk associated with COVID-19 is associated with the tendency in some people for an excessive or persistent inflammatory response. When the inflammatory response is high the symptoms are apparent and if they result in shortness of breath or difficulty breathing it is important to seek medical care directly.  At times, the inflammatory response is more low-grade and persistent. In this case the symptoms are less extreme, but can weaken a person overtime. 
4. Recovery.  The aim of the recovery phase is to resolve inflammation in order to inhibit tissue damage and to restore and optimize functioning in the body.  Continual clinical surveillance, such as blood work, is an important step to ensure that the body has fully recovered after being sick with COVID-19 or any other infection.

When Are Your Symptoms A Concern?

Research continues to point to the fact that the majority of those that have COVID-19 will not have any noticeable symptoms or will experience mild symptoms that resolve without medical intervention. Trusting your innate healing ability is a foundational principle of naturopathic practice.  It is also true that if the body is struggling to recover, you will have symptoms that will help to guide your medical practitioner to determine the cause.

If your symptoms come on suddenly AND you feel exhausted or unwell for more than three days it would be worthwhile to contact your medical practitioner or Public Health and get tested.  It may also be concerning if your symptoms are accompanied by a loss or altered sense of  smell that doesn't seem to resolve. This study also highlighted that an altered sense of taste and/or smell often proceeded other symptoms.

In naturopathic practice we acknowledge the "never-well-since" aspect of any illness or accident. Generally speaking the body is designed to handle life's stressors and challenges and to heal, but at times it gets stuck and the body doesn't recovery properly.  This healing process can become stuck due to nutrient deficiencies, other underlying conditions, medications or environmental factors and at times it is unable to heal due to the psychological impact of the injury.  Anytime that a person feels that they have "not been well since  . . . ", it is important to talk to your naturopathic doctor or other health practitioner to figure out what needs to be addressed for the body to heal.  If someone feels that they were unwell earlier this year and that they haven't fully recovered it would be helpful to have laboratory tests done to ensure that the inflammatory phase of COVID-19 was properly resolved and that the body has fully recovered from COVID-19

COVID-19 is a new disease and the information that we have on it is changing and evolving all the time.  What is the most important is your overall health and safety.  If you have any questions, please talk to health practitioner.

Associated Blogs

Don't Wait Until You're Sick To Get Healthy

Food And Immune Health

A Crash Course on Respiratory Health

Reference

Giacomo Spinato, Cristoforo Fabbris, Jerry Polesel, et al. Alterations in Smell or Taste in Midly Symptomatic Outpatients with SARS-CoV-2 Infection. April 22, 2020.  JAMA doi:10.1001/jama.2020.6771

Yanuck SF, Pizzorno J, Messier H, Fitzgerald KN. Evidence Supporting a Phased Immuno-physiological Approach to COVID-19 From Prevention Through Recovery. Integrative Medicine: A Clinician's Journal.  May 2020

Maggini S, Pierre A, Calder P. Immune Function and Micronutrient RequirementsChange over the Life Course. Nutrients. 2018.

Marinosci A, Landis B, Calmy A. Possible Link Between Anosmia and COVID-19: sniffing out the truth.  Eur Arch Otohinolaryngol. 2020 April 17. 1-2.  PMID: 32303881.

B12 Deficiency, a Growning Concern in Children and Adults

By Dr. Iva Lloyd, ND

Vitamin B12 is a water-soluble vitamin that is naturally present in foods that come from animals, including fish and shellfish, meat (especially liver), eggs and milk products, as well as fortified cereals and other fortified foods. With changes in dietary patterns and other factors, vitamin B12 deficiency is becoming a major concern.

Symptoms of Vitamin B12 deficiency

Vitamin B12 is required for proper red blood cell formation, neurological function and DNA synthesis.

Signs of B12 deficiency in adults include:

• altered or decreased growth of cells and poor oxygen-carrying capacity of blood
• impaired neurological function including diabetic neuropathy, peripheral neuropathy and vertigo
• increased susceptibility to infection and/or gastric mucosal atrophy including disturbed digestion, nausea, anorexia, diarrhea or constipation and urinary incontinence. 
• The mental symptoms of Vitamin B12 deficiency are extremely variable and include disorders of mood, mental slowness, memory defect, confusion, severe agitation and depression, personality disorders, delusions and even paranoid behaviour or hallucinations. 
• There is a very strong correlation between Alzheimer's disease and vitamin B12 deficiency.

Signs of B12 deficiency in children include:

• developmental delays or regression in behaviour and impaired neurological development including seizures, mental retardation and even Autism.
• irritability, apathy, as well as, ADD and ADHD type behaviour. 
• Treating B12 deficiencies in children is critical for their development, both physically and mentally.

What causes a deficiency?

A deficiency of B12 can be caused by:

• food intolerances can result in blow B12 levels
• digestive issues, especially hypochlorhydria (low stomach acid) or any condition that impairs the mucosal lining of the gastrointestinal track
• decreased consumption of dietary red meat, fish or eggs
• vegetarian diets increase the risk of deficiency for both an individual and for any breastfed children
• increased consumption of folate-fortified foods and supplements
• some parasites and bacteria compete for the available B12 which can result in a deficiency
• there are some conditions such as Multiple Sclerosis, endocrine disorders, hemorrhage and other conditions that deplete B12 levels
• surgeries that involve the removal of part of the colon often results in B12 deficiency
• exposure to medication which depletes B12 status or block Intrinsic-Factor-mediated B12 absorption (birth control, antacids, heartburn medications, anti-epileptics, etc.) 

The Link between folate and Vitamin B12

Over the last twenty years specific foods have been fortified with folate. Folate fortification and maternal supplementation were a public health initiative aimed at reducing folate-deficiency neural tube defects at a time when populations were eating large amounts of red meat (B12 rich) but few fruits and vegetables (folate-rich).

Part of the rise in Vitamin B12 deficiency rates is due to the high amounts of folate-fortified foods that individuals have consumed over an extended period of time. High levels of folate block Vitamin B12 and can both mask and exacerbate B12 deficiency symptoms.

Testing for Vitamin B12 deficiency

The normal blood testing for Vitamin B12 levels is often not diagnostic and normal values do not exclude B12 deficiency. If you experience any of the symptoms above, I encourage you to ask your naturopathic or medical doctor to run a blood test for both Vitamin B12 levels and for RBC folate.  A high level of folate will result in a Vitamin B12 deficiency, even if your blood level of Vitamin B12 is normal.

Because of the strong link between Vitamin B12 levels and decreased cognitive function, it is often recommended that anyone with signs of memory loss be tested for Vitamin B12 deficiency.

Another way to gauge Vitamin B12 deficiency is to request an intra-muscular injection of Vitamin B12 and see if you notice any symptoms.  Generally speaking, a positive result to a Vitamin B12 injection will be noticed within 48 hours.

Treating Vitamin B12 deficiency

Monthly intra-muscular injections of B12 are the most efficient way of building up low levels of B12 in the body. Often after the first injection there is a notable improvement in either energy, cognitive function or sleep. Vitamin B12 injects are generally regarded as very safe.

Depending on your levels, it can take between 3 and 6 months, or more, to re-establish normal B12 levels. For mild symptoms or once levels have been re-established with intra-muscular infections, sublingual Vitamin B12 may be indicated, especially if there is also a decreased consumption of B12 rich foods.

There are three types of B12:

1. cynocobalamin is the most common and least expensive form of B12. It is the form that is often used in the United States for intra-muscular injections.
2. hydroxycobalamin lasts longer in the body and requires less frequent injections. It is often considered more potent than cynocobalamin.
3. methylcobalamin is the most expensive form of B12. It is more effective when B12 injections are being used for cognitive concerns or for peripheral or diabetic neuropathy.

If you suspect that you have a B12 deficiency and you have been taking B12 injections without much improvement, I encourage you to request a different form of B12.

Vitamin B12 deficiency is very common and is very easy to treat.  If you are suspect that you may be deficient I encourage you to get tested.  For more information talk to your naturopathic doctor.

Don't Wait Until You're Sick to Get Healthy

by Dr. Iva Lloyd, ND

This current health crisis is affecting our lives in ways that we could have never imagined a month ago. We have the uncertainty surrounding the virus, the economic impact, the self-isolation, the
reality of the death toll around the world and the concern for family and friends, to name a few.

At times like this, it is important to approach the problem from as many perspectives as possible. The guidelines set by Public Health and Ministries of Health are essential and need to be followed. The government's aims to the protect the public and to make decisions that are the best for the population at large. Healthcare practitioners are there to ensure that you have the support and care that you need when you need it.

It is important to recognize that there are a lot of things that you can do as well to support your mental, emotional and physical health. Health crises have a way of reminding us that lifestyle and self-care are  important. They determine our ability to handle something that threatens us. The best you can do for your family and friends right now is to focus on your individual self-care and that of your family and loved ones.

Don't Wait Until You're Sick

Health is a accumulation of your life. Starting with your genetic makeup and your exposures during pregnancy to your present health status. It includes the accidents, injuries, lifestyle choices and decisions that you have made throughout your life and how you have handled them. It is based on the

balance encompassing the food and drink that you have consumed, the experiences and choices that have added positively to the strength of your resiliency and those that have deterred from it.  The body was designed with a tremendous ability to heal and recover, especially in early and mid-life. As you get older, the body's innate functioning is more on maintaining health which is one of the reasons that chronic diseases are diagnosed more so after the age of 60. Remaining healthy throughout life is about making choices - throughout your life - with health in mind.

The impact of any threat on the body is a balancing act. Which is stronger and has more "power"?  The question is whether or not the threat is greater that the a person's resiliency?  Who or what is going to "win"?  The threat can be a stressful situation - like the loss of a job, the death of someone that we love, or a sense of despair.  It can be a diet that is lacking in nutrients, excess of smoking or alcohol, or a chronic lack of sleep. The threat can be exposure to heavy metals or chemicals, a sensitivity to wireless technology or it can be a virus or pathogen that threatens health. Everyone is unique and has their own specific susceptibilities. Some are more sensitive to food, others to environmental toxins and wireless technology, some tend to get more emotionally overwhelmed and others are more impacted by pathogens such as viruses, bacteria or mold.

In this current crisis, it should not surprise anyone that there is so much confusing information. The human factor is too often missing and when included can shed a lot of light. We have seen this same situation repeatedly in the past. Different people respond differently to the same "threat".  If we try to make sense of this virus, any virus, by only considering the virus and not the human factor, it will unlikely never make sense.

Check out the video from the World Naturopathic Federation on building a shield of wellness.

Focus On What You Can Control

There are so many factors that affect health. Trying to focus on all of them at the same time is overwhelming. It is important to be aware of those factors that are out of our daily control - unless you have chosen to be an advocate for a specific cause - and to focus on those that you can influence more readily.

Ubiquitous Health Factors are those that are all around us. They are created by manufacturing, technology, climate change and other global issues. The include things such as acid rain; pollution and destruction of the water, air and soil, natural disasters; pathogens; plastic, wireless technology and the additives and chemicals that are put in the food that we eat. It is important to be aware of these and we all need to do our part, but they are not factors that you can have control over in a crisis.

Controllable Health Factors are those healthy habits that you can influence. They are the ones that you can choose to do or not do. From a naturopathic perspective, they are an essential aspect of health. They include the food you choose to eat, your lifestyle habits, sleep hygiene, how you manage your stress; your posture; whether or not you breath properly; your movement and exercise; the time you spend in nature and the limitations you put on your wireless exposure. There are so many ways that you can improve the status of your health and that of your family and loved ones.

The following provides an overview of the main health factors that you can influence on your own.

Nutrition

One of the tenets of naturopathic practice is that health starts with a healthy diet and healthy digestion.

What you eat and your ability to digest your food determines the water and nutrients that your body has to work with. There are numerous biochemical pathways that control how the body functions. Those pathways and the building and maintenance of every structure (bone, muscle, tissues, blood, etc) depends on nutrients.

In my blog, Food and Immune Health I go over the link between food and immunity, highlighting the need to have a whole foods diet with lots of fruits, vegetables, lean protein, whole grains and nuts and seeds. The aim is have food from every food group every day.

One of the risks of both stress and self-isolation is the tendency to eat unhealthy foods and to snack more often. I encourage you to focus on diet as a staple for health. Ensure you get adequate water, eat according to your activity level.  If you are less active it is often helpful to eat less so that you don't put on unwanted weight.

Stress can also results in an increase in "comfort" food and drink, such as sugary desserts, pop, alcohol, chips and junk food. It is best to limit these during a time when the focus needs to be on optimizing immune health.

Check out our other blogs on nutrition for more tips:

• Nutrition - Top 5 Things to Remember
• Water - Top 5 Things to Remember.

Sleep

Sleep is essential to health. It is the time when the body heals, repairs and recovers from the stress of the day. Getting adequate sleep is associated with better overall health and vitality. It decreases the rate of aging and improves mental and cognitive function. 

Those with adequate sleep generally have a strong immune system and a stronger immune response. Ideally, at the first sign of not feeling well you want to slow down and allow the body time to heal. Turn off the alarm and let the body sleep as much as it desires. If you struggle with getting good quality sleep, talk to your naturopathic doctor to figure out the best strategy for you.

For more information, check out our blog on Sleep - Top 5 Things to Remember.

Movement

Daily movement is essential to optimal immune health, especially when we are talking about immune and respiratory health. Regular exercise or movement is associated with a decreased risk of respiratory infections and a decrease risk of infections becoming severe. Anyone who has specific health concerns is always best to talk to their naturopathic doctor, but some general guidelines to follow include:

• Walk. Aim for a twenty minute walk once or twice a day.  If you are in self-isolation, than it is helpful to walk around your house or room a couple of minutes every hour.
• Stretching. If you want to maintain flexibility throughout your life it is important to stretch on a daily basis.  If you already have some limitations in flexibility than start by stretching while sitting in a chair.
• Swimming. If you access to pool, swimming is a great exercise and it is one of the best for those people that have joint problems.
• Releasing stress. Movement is a great way to help release stress. A short burst of activity, such as hitting a tennis ball against a wall, punching bags or kick boxing can be helpful in releasing stress.

The most important thing is to stay active.  For more information, check out our blog on Movement - Top 5 Things to Remember.

Breathing

Breathing is essential to life. It is linked to every function in the body. The ability to take a deep full breath is an indicator of overall respiratory function. There are so many different ways that you can use breath to improve your overall state of health and well being. For example,

• Cleansing breath.
• Exaggerated exhalation.
• Alternate nostril breathing.

I recommend that you take a few minutes to really feel and listen to your breath. Are you breathing deeply?  Holding your breath is very common in times of uncertainty and fear.  If you are holding your breath practice the cleansing breath or the exaggerated exhalation (details on the Breathing blog).  If you are having difficulty sleeping, the alternate nostril breathing can be helpful to settle the mind. Mastering breath work will help improve your physical and mental state of well being.

For more information, check out our blogs on Breathing - Top 5 Things to Remember and Breathe Better With Self Care Techniques.

Stress Management

Stress is not always bad. There is "good" stress which has to do with being busier or having a lot to do.

Stress impacts health negatively when it is intense, recurring or unrelenting, Stress has the greatest impact when your body goes "on hold", when you feel trapped or there is a sense of despair or uncertainty. Your stress management skills determine the impact that stress and traumatic events have on the body.

It is helpful when under times of "bad stress" that you focus on what you can control. For example:

• Practice breathing exercises every day. When you feel uptight do some exaggerated exhalations or cleansing breaths.
• Be sure to stay active. If possible, walk outside and enjoy the fresh air and sunlight.
• Avoid binge watching movies or spending hours on your laptop or computer.
• Limit how much time you spend listening to the news.  Give you mind a break and focus on something enjoyable or productive.
• Now would be a good time to read up on mindfulness or meditation.
• Finish the story!  Don't block the mind from thinking things. Allow the mind some time to plan out what will happen if this current situation continues for another month, or two, or three.  One of the worst things for the mind is spinning on a topic, that is thinking the same thing over and over and never coming to a resolution. It is helpful if you can guide the mind to think through problems.
• Be productive. Recognize that you can't change the current situation and focus on something productive that you can do.

For more information, check out our blog on The Power of the Mind - Top 5 Things to Remember.

Other blogs that you might find helpful during this time of physical distancing:

• Copying with Change & Anxiety: Ayurvedic Tips
• Is Change Causing You Anxiety?
• Wireless Technology - 5 Safety Tips

When this current crisis is over the question will be "What were you doing during the COVID-19 crisis".  What do you want your answer to be?

Food and Immune Health

By Dr. Iva Lloyd, ND

What you eat truly is the foundation of overall health.  But, choosing the ideal diet can be challenging as the "right diet" can vary based on age, health status, food intolerances and other factors.

This current health crisis is reinforcing the need for a healthy diet as the health of your immune system is strongly linked to what you eat and what you don't eat.  When looking at diet from the lens of immune health it can be helpful to increase foods that support immune function and ensure adequate hydration, and to limit foods that cause inflammation or that impede immune function.


The following is a general guide. For recommendations specific to you or your family members it is always best to work with your naturopathic doctor.

General "Rules"

Although there is not one diet that is best for everyone, here are some general "rules" to keep in mind:

1. Eat primarily to be healthy
2. Eat from all the food groups
3. Ensure proper portions. 
4. Eat regular meals.
5. 75% whole foods 

To learn more about these general rules, check out our blog Nutrition - Top 5 Things to Remember.

Foods That Support Immune Function

A balanced diet is essential to proper immune function. The following is an overview of the nutrients that are required for the immune system to work properly and the foods that contain them:

• Vitamin C: blackcurrant, broccoli, citrus fruits, kale, parsley, spinach
• Vitamin A: carrots, sweet potatoes, spinach, chicory, dill, dried apricots, egg yolk, kale, liver, parsley, red pepper.
• Vitamin B6: avocados, walnuts, spinach, nuts and seeds, whole grains
• Vitamin B12: beef, poultry, fish, dairy, sauerkraut, seaweed
• Vitamin D: butter, dairy, eggs, liver, sardines, mackerel, oatmeal, oysters, salmon, shitake, sprouts, sweet potatoes, tuna
• Omega 3 oils: fish such as sardine, mackeral, salmon and tuna, almonds, avocado, beans, chia seeds, linseeds, olive oil, spinach, walnuts
• Folic Acid: dark leafy greens, asparagus, broccoli, citrus fruit, dried beans, peas, whole grains.
• Copper: liver, oysters, cashews, soy beans, dark leafy greens, avocados, kale, linseeds, pumpkin seeds, walnuts, brazil nuts, pistachios, pine nuts, legumes, dried fruits
• Zinc: oysters, seafood, pumpkin seeds, beef, chicken, cashews, brazil nuts, oatmeal, sunflower seeds, hazel nuts and whole grains.

Nutrient deficiencies are a global problem.  Research indicates that deficiency in nutrients impairs immune function, contributes to chronic disease and increases the risk of mortality.  Health and longevity is strongly correlated with overall nutritional status.

Foods That Contribute to Inflammation

When the immune system is overwhelmed it creates inflammation. This inflammation can often do more damage than the pathogen or toxin that it is trying to protect the body from.  Avoiding foods that add to the inflammatory process, especially if you have respiratory symptoms such as cough, shortness of breath or fatigue, will assist you recovery.  The following strategies will help limit the amount of inflammation due to food:

• If you have known food intolerances, it is recommended to limit these as much as possible.
• Limit refined carbohydrates such as white bread, pastries, cookies, white rice and other "white" highly processed foods.
• Avoid trans fats, vegetable oils and foods high in sugar.
• If you have mucous-related symptoms limit dairy, wheat, yeast and bananas. Fruit is healthy, but it is important to limit your fruit intake to a couple servings a day.

Stay Hydrated

Ensuring regular hydration is an important aspect of immune health.  The following foods can help ensure adequate hydration:

• Water. Drink about 1/2 your body weight in ounces a day.
• Herbal teas are a great alternative. There are a number of herbal teas that also support immune and respiratory health.
• Green drinks and diluted vegetables juices can be beneficial as long as the sugar content is minimized.

For more information, check out our blog on Water - Top 5 Things to Remember.

Foods That Might Weaken Immune Function

There are some foods and drinks that impede immune health. To ensure that your immune system stays strong limit the following foods:

• Sugar. The consumption of refined glucose, fructose, sucrose, honey, pop and high-sugar juices, has been shown to compromise the immune system for three to five hours. The most important thing you can do when you are sick or when you are concerned about your immune system is to stay away from all processed sugar.

Salt.  Avoid high-salt foods such as processed meats, and packaged soups and foods. Salt adds to the inflammatory response and weakens overall immunity.

• Junk Food. Most people enjoy a bit of junk food every now and then, but it is important to limit it or avoid it completely when working on strengthening overall immune health. Junk food is generally nutrient deficient, high in salt and/or sugar and high in food additives.

Eating healthy is pretty straight forward it you have a lot of variety and ensure that the majority of food that you eat is whole food.

If you would like any guidance on what is best to eat for you or your family, please work with one of our naturopathic doctors.

COVID-19 Q&A

by Dr. Iva Lloyd, ND

A crisis generally evokes confusion, anxiety and for some fear; and this pandemic is no different. To a large degree, the anxiety is due to the fact that there are so many unknowns - which is understandable as this virus is new.

As a naturopathic doctor, what I find encouraging is that there have been hundreds of research papers  published in the last few months. Doctors and researchers are madly working to understand how to manage COVID-19.  Rest assured that the information we are gathering is helping the medical profession figure out what needs to be done.  I trust the following answers some of your questions:

Q: What are the symptoms of COVID-19? 

A: The most common symptoms of COVID-19 are a fever, dry cough and shortness of breath or tiredness. A person might have additional symptoms such as aches and pains, runny nose, sore throat or diarrhea, but at least two of the three main symptoms are generally present. 

Q: Who can get COVID-19? 

A: Anyone can get COVID-19, but currently older adults that have hypertension, heart disease, diabetes or lung disease are at a higher risk of developing serious complications. It is important that everyone be diligent and take the proper precautions. 

Q: How is COVID-19 spread? 

A: The virus is believed to be spread primarily by person-to-person through respiratory droplets from a sneeze or cough of an infected individual. It can also be transmitted by touching surfaces where infected droplets have recently landed. 

Q: Is the COVID-19 virus airborne?

A: NO! COVID-19 virus is NOT airborne. It is spread through respiratory droplets produced when an infected person coughs or sneezes. The respiratory droplets quickly fall to the ground or on a surface. They only stay in the air for a very short period of time. 

Q: How long do the respiratory droplets last on surfaces?

A: Respiratory droplets can last between two to three days on plastic and/or stainless steel.  Keep in mind, the viral-load (concentration) of the droplets decreases quite quickly. Respiratory droplets can appear on other surfaces (e.g. clothing) but they do not last for very long and are not easily transmitted to someone from these surfaces.

Q: Why the 6 Foot Rule?

A: You never know when you may cough or sneeze and the six-foot rule is based on the fact that respiratory droplets from a sneeze or cough may travel up to six feet. Social distancing is primarily about protecting you from a cough or sneeze.  Coughing and sneezing into a tissue or into your sleeve is important to contain the spread of respiratory droplets. 

Q: What is Social Distancing? Why is it important? 

A: Social distancing, quarantines and self-isolation are terms in wide use during the COVID-19 pandemic. Social distancing involves avoiding crowds and keeping a safe distance between you and others when shopping or going for a walk.  It is a preventative measure through limiting inter-personal contact. Until we understand more about COVID-19, it is important to follow the social distancing guidelines set by your government.

Q: How can I protect myself from COVID-19?

A: The best way to prevent illness is to avoid being directly exposed. Four things to keep in mind:

1. The most important is to avoid close contact with anyone who is showing symptoms of COVID-19 or who has been diagnosed with COVID-19.
2. Wash your hands frequently especially after coughing or sneezing and being in public places. Wash your hands with soap and water for at least 20 seconds. If soap and water is not available, use hand sanitizer.  Avoid touching your eyes, nose, and mouth with unwashed hands after touching surfaces that others would have commonly touched. 
3. Practice social distancing. 
4. Maintain a healthy lifestyle. 

Q: If you have symptoms or if you have tested positive for COVID-19, is it important to self-quarantine? 

A: YES.  First and foremost, if you have symptoms of COVID-19 it is important to call your local public health for testing. Anyone who has symptoms or has been tested positive MUST self-quarantine as directed by public health, usually for 14 days.  When self-quarantining it is imperative that you stay home, avoid visitors, and stay at least six-feet away from other people in the household. It is also important to avoid sharing things like towels and utensils and that you use standard hygiene measures. Ask friends and family to do your shopping and drop groceries or other supplies outside your door, in order to limit personal contact. If your symptoms worsen, call public health and they will direct you further.

Q: How long is the COVID-19 incubation period?

A: FIVE days! The time between exposure and showing symptoms of the COVID-19 virus can be 1-14 days. Most commonly it is about 5 days. 

Q: What is flattening the curve? Why is it important?

A: Flattening or slowing the rate of infection helps prevent overloading of local healthcare providers. Social distancing helps to spread out the rate of people with severe symptoms so that the hospitals are able to effectively manage the situation and it gives researchers and other medical professions more time to understand how to manage COVID-19.

Q: Can I get the COVID-19 virus from my pet?

A: NO! There is no evidence that pets can carry the COVID-19 virus. However like any surface that an infected person sneezes or coughs on, infected droplets can be carried on pet fur for a short period of time. Anytime you happen to cough or sneeze on your pet, please wipe their fur down with a damp towel before another family member or another person interacts with them.

Q: Who should wear a facemask?

A: If you are sick wear a facemask when you are around other people and before entering a public place or a healthcare provider's office. A facemask minimizes the chance that a cough or sneeze will affect others. If you are unable to wear a mask, or do not have one, it is important to follow the proper hygiene protocol for a cough or sneeze and to avoid close contact with others.  If you are NOT sick it is only necessary that you wear a facemask if you are caring for someone who is sick. 

Q: Is it helpful to wear gloves?

A: Gloves are necessary for those in the service industry, especially with those involved with food preparation or handling. For the general population, gloves are not necessary.  Gloves, whether they are latex, cloth or winter gloves, can all carry the virus. When you touch a surface that has respiratory droplets from the virus then the virus may be transferred to your gloves. My experience is that people are more likely to touch their face while wearing gloves than they are to touch their face if they are hanging onto a disinfectant wipe or tissue.  Keep in mind, healthcare workers have an increased risk of exposure and wearing gloves is important for them.

Q: What is the overall mortality rate of COVID-19?

A: It is going to take awhile to figure out the actual mortality rate (the number of people who may die if they catch COVID-19).  The World Health Organization (WHO) currently suspects that the mortality rate is around 3.4%. It currently appears higher in some countries (such as Italy), but is also much lower in other countries.  As the testing for COVID-19 has primarily focused on those that have symptoms, there is a chance that the mortality rate will decrease as we learn more about this virus.

Q: How many people who get infected will have significant symptoms?

A: Research currently indicates that about 80% to 90% of those that have the virus will be asymptomatic or will have mild or moderate symptoms. Which means that about 10% to 20% will have concerning symptoms that will require medical intervention or hospitalization. That being said, it is important for everyone to practice proper hygiene and social distancing.

Q: How many people will someone who is sick infect?

A: Reproductive rate is a measurement of how many people an infected person will infect. For example, the reproductive rate for the common flu (Influenza) is one - which means that for each person that is sick they will infect one other person. Recent research is indicating that the reproductive rate for COVID-19 is between 2 and 2.5.  There is speculation that as we learn more about COVID-19 the reproductive rate may actually decrease closer to that of the flu. 

Q: How long is someone who is infected able to infect someone else?

A: It is generally believed that someone who is showing symptoms can affect someone else for about 10 days. The term viral shedding relates to the ability of the virus to move from one part of the body to another (i.e., from your hands to your mouth) and from an infected person to the environment (i.e., from an infected person's hands to a hard surface) where it can affect others.  The current research indicates that it less likely that someone who is symptom-free will affect others with the virus.

Q: What is the difference between COVID-19 and SARS-CoV-2?

A: COVID-19 stands for Coronavirus Disease 2019. It is the name of the disease. SARS-CoV-2 stands for SARS (Severe Acute Respiratory Syndrome) Coronavirus 2 and it is the name of the virus.

Q: What is the source of SARS-CoV-2?

A: Based on the analysis of the virus, the source is from a dead animal. The transfer from animal to human would have occurred at a meat or fish market when humans were interacting with meat - NOT a live animal and NOT from a pet. At this time, the actual animal source has not been found but many are working tirelessly to figure it out. Part of the "unknown" factor for SARS-CoV-2 is that it originated from an animal and hence humans do not have the same natural immunity to this virus.

Q: How can your naturopathic practitioner help?

A: The naturopathic community is here to help you through this pandemic. Check out our blog "A Crash Course on Respiratory Health" The focus of naturopathic practice is to provide:

• Health Promotion: guidance on a healthy lifestyle
• Prevention: reinforcing the importance of hygiene and social distancing
• Supportive Care: providing guidance on how to support your overall health. Currently there are no proven treatments - conventional or naturopathic - for COVID-19.
• Recovery: helping patients recover and reestablish their health if they have had any symptoms.

Q: What is best to do when home in self-isolation or quarantine for a couple of weeks?

A: Situations like this are a good reminder of the importance of a healthy lifestyle. Here are some tips while in self-isolation:

• First and foremost, create a routine. Plan out your day. Avoid the tendency to sit around and watch movies or television all day.  
• Exercise is important. This might be a great time to focus on stretching, walking (even if it is around your house) or other activities you can do at home.
• Work on a project. Take the time to clean out the garage, paint a room in the house, clean out those closets that you never get to, or other tasks at home.
• Eat healthy.  This is a time to focus on healthy eating. Avoid filling up on junk food and high starch foods. To help the body stay healthy, eat your fruit and vegetables, adequate protein and healthy starches. 
• Keep in touch with friends and family. Self-isolation and quarantine can be quite uncomfortable for may people. It is important to reach out to others. 
• Mindfulness and meditation are very helpful in times of stress.  If you are not familiar with these coping strategies there are a number of apps that you can download and enjoy.
• Limit the amount of time that you are listening to the news. Think of news, especially "bad news" as a challenging workout for your mind. Like any muscle, it can handle a bit, but it can't handle too much!

By ensuring a holistic approach to this problem, we will get through this pandemic together. As new information and research is available the global health care community will master this infection as it has all others.

If you have any questions, please call to speak to one of the naturopathic doctors in our clinic.

 

A Crash Course on Respiratory Health

by Dr. Iva Lloyd, ND

We recognize the distress that the COVID-19 crisis is causing many people.  We do hope that you and your loved ones are safe, healthy and following the advise from public health officials.  Is there reason for concern - Yes.  Is there reason for panic - No.  Often the difference between the two is information and reason.  I hope the information below provides you with both.

There are five main aspects of healthcare to address which includes:

1. Health Promotion / Healthy Lifestyle
2. Prevention
3. Self Isolation / Quarantine Recommendations
4. Supportive Care
5. Recovery

To understand what is required for each of these steps we have to look at what we currently know.  The World Health Organization (WHO) has over 325 clinical trials going on with respect to COVID-19.  The results of these studies will help guide every aspect of how this virus is managed. It is also important to keep in mind that our understanding of this virus is growing and changing daily.

What Is The Risk

• The reason for concern is that the COVID-19 virus has a higher mortality rate than the seasonal flu.  It is also spreading  significantly faster than the seasonal flu. 
• It is important to keep in mind that ONLY about 6% of people that get COVID-19 experience significant symptoms - which means that 94% of individuals that get the virus will have mild symptoms.
• Of the 6% that have significant symptoms, 50% are recovering when they receive proper medical treatment.
• We also know that when someone has severe symptoms it is important that they get oxygen and medical care quickly.

According to the current research, the people at greatest risk are those over 70 years of age AND that have compromised immune function, diabetes and/or hypertension or cardiovascular disease.  

Children and young people may be carriers, but they do not appear to be overly affected by this virus.

Studies have also showing that in pregnant women that are affected with COVID-19, their newborns are not being affected.

Research is suggesting that the warmer weather may actually decrease the spread of the virus.

How COVID-19 is approached depends on addressing both factors - the virus and its impact to lung function, especially as it relates to oxygen carrying capacity.

Health Promotion / Healthy Lifestyle

From a naturopathic perspective the impact to health of any infection depends on two things - the first is susceptibility and the second is exposure.  Health promotion is about adopting a healthy lifestyle which contributes to decreased susceptibility.  The one thing that this current crisis has reminded us is the importance of choosing a healthy lifestyle.  The following guidelines may be beneficial in supporting overall health. For specific recommendations it is important to work with your naturopathic practitioner or medically trained health care practitioner.

• Stay hydrated: Ensure adequate hydration. It is important to drink healthy fluids throughout the day.
• Clean balanced diet: Limit known food intolerances; ensure balanced nutrition including lean protein, vegetables and whole grains; and limit foods that contribute to mucous (such as excess bread, dairy, yeast and bananas).  Limit processed food and foods high in salt and sugar.
• Spices: Many warming spices have anti-microbial and anti-viral properties. Spices such as garlic, ginger, thyme, oregano and sage are easily added to teas and food dishes. 
• Sleep: Ensure adequate sleep. When you have symptoms of a cold or flu it is common to require more sleep.
• Stress Management. Reduce and manage stress.  Immune function and breathing are closely linked to stress. Focusing on stress reduction techniques are always beneficial.
• Indoor pollutants. Address indoor pollutants such as mold as they can worsen lung related illnesses.
• Avoid smoking. Smoking and exposure to second-hand smoke can increase your susceptibility of lung-related illnesses.
• Exercise: Moderate exercise enhances immune function and lowers the risk of respiratory infections. Intensive exercise can suppress normal immune reactions and is best avoided if unwell.

To learn more about engaging in a healthy lifestyle check out our website.

Prevention

Prevention is about decreasing exposure. In the last few weeks we have all had a crash course on hygiene and preventive measures.  According to the CDC, we are still learning about how this specific virus is transmitted.  The main preventative steps (taken partly from the World Naturopathic Federations's Update) include:

• Greeting Someone: When greeting someone (yes, even children!) is it important to keep distance.  Instead of hugging, kissing or shaking hands, use an elbow bump or acknowledge with a nod or a slight bow. 
• Hygiene: Wash your hands often with soap and water. Always wash your hands before preparing food and before eating. Avoid touching your eyes, nose, or mouth with unwashed hands. Use your knuckle to touch light switches, elevator buttons, etc.  Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door - or use a paper towel or wipe when touching public surfaces.
• Cough hygiene: Cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the trash and wash your hands. If you don’t have a tissue, it is better to cough into your shirt sleeve; not your hands and always wash your hands after coughing or sneezing.
• Food hygiene: Avoid sharing water, food, or products (glasses, cutlery, hygiene products) with someone who has a respiratory infection.
• Clean surfaces: Whether grocery shopping, flying or exposed to something new, clean and disinfect all objects and surfaces that you touch. 
• Avoidance: Avoid close contact with people who are sick. If you have a cold or flu stay home to limit your risk of spreading the infection to other and to support the healing process. Avoid large crowds when the risk is high. If you choose to wear a mask, choose a mask that covers both your nose and mouth.

Self-Isolation / Home Quarantine

With the aim of containing the virus, governments are increasingly encouraging self-isolation or home quarantine for individuals that have symptoms, have traveled to high risk areas or where the rate of infection is high.  It is important to follow the guidelines of your region.   For information on self-isolation guidelines here is the link from Canadian Ministry of Health.  The focus of this blog is on how to maximize health while at home. 

First and foremost, if you have symptoms it is important to call your local Public Health authority.  Here is the link with the numbers. 

If you are at home I encourage you to take it as an opportunity for some self-care for you and your loved ones.  I encourage you to review the health promotion guidelines listed above and the supportive treatment guidelines listed below.

Supportive Care

There is no current treatment specifically for COVID-19.  As stated above there are over 325 clinical trials that are in progress.  They include the use of Intravenous Vitamin C, different herbal formulation and other natural therapies. We will let you know the outcome of those trials as they become available.

Although the large majority of people will have mild symptoms, it is important that anyone with significant symptoms (fever, shortness of breath, strong cough) notify Public Health and follow their guidelines.

If your symptoms are mild, to accompany the recommendations from Public Health, naturopathic supportive care may include addressing immune and respiratory function, especially as it relates to oxygen carrying capacity. As with any condition it is always best to talk with your naturopathic doctor or health practitioner to determine what is best for you specifically, but some general recommendations include:

• The importance of food when supporting health can not be overstated.  It is always an important aspect to staying and achieving healthy.  Increase foods high in oxygen and nutrients, which includes fruits and vegetables. Dark green leafy vegetables are a great source of oxygen.  Fruits and vegetables also have the vitamins and minerals needed to support healthy blood formation.  Specific foods that may be helpful include spinach, kale, broccoli, sprouts, berries and citrus fruits, watermelon, sweet potatoes, carrots, beets, avocado, fresh fish, onions, garlic, ginger, cinnamon and turmeric.
• Reducing alcohol, sugar and refined foods would be advised.
• As this virus affects lung capacity, avoiding foods such as dairy, wheat, yeast, bananas would be beneficial.  If you are aware of any specific foods that cause you mucous or other symptoms, it would be beneficial to avoid them at this time.
• Stay hydrated.  Water carries oxygen to the cells. Increasing the intake of healthy fluids (water, green drinks, vegetable juices) may be beneficial.
• Regular exercise.  Take the time to exercise everyday.  Walking is ideal. Focus on exercises that support cardiovascular system.  
• Spend time outside (if not in isolation). On a nice day, go for a gentle walk outside.  Spending time in nature is beneficial to the immune system, the respiratory system and can help decrease stress.
• Stay calm.  This too will pass!!  Practice deep breathing, relaxation, meditation and other exercises focused on stress reduction.
• There is some indication that reducing your exposure to Wifi may also be beneficial in supporting overall health. For further information on wireless technology, check out my blog on Wireless Technology - 5 Safety Tips.

Other supportive therapies for immune or respiratory health or to assist in managing the stress associated with this crises such as:

• Nutraceuticals that help support oxygen carrying capacity of the lungs such as Chlorophyll or NAC.
• Herbs specific for the immune and/or respiratory function such as Cordyceps, Ginkgo biloba, Ashwaganda
• Vitamins such as Vitamin A, B, C or D
• Mineral supplementation such as zinc lozengers
• Tissue salts, essential oils and /or homeopathics may also be beneficial for some individuals

Recovery

Ensuring that you recover from any acute infection is always important, and often overlooked.  The steps to recovery include those of a healthy lifestyle and include individualized recommendations outlined in the supportive treatments section above.

It is always best to work with your Naturopathic Doctor or other trained health care provider to ensure that you fully recover from any acute illness.

When everything is said and done the best advise is to be diligent, informed and reasonable.  Understand your personal risk.  Take steps to stay healthy.  If you have symptoms act quickly and follow the guidelines in your local area.

Remember that Canada has a very strong health care system.  It also have a lot of open spaces and access to healthy foods.  As new information becomes available we will share it with you.

If you have any questions please call to book with one of our Naturopathic Doctors.

Please remember, if you have symptoms or suspect you have COVID-19, please contact your local Public Health authority.