The COVID-19 pandemic has caused many of us to consider how well we can fight off (and recover from) not only COVID but illness in general. After spending pretty much all of my 20s focusing on absolute strength in powerlifting, the past couple of years, I began putting more intentionality into other aspects of my total health (in addition to my strength training). It began as I wanted to lower my body fat percentage and better my cardiovascular shape. It continued to evolve as I looked to solve my ever-growing digestive issues, lifelong mental health challenges, and most recently, greater attention to immune system health. Little did I realize how these would all tie together.

As the GM of a large Community Center, I've also had to be active in watching public policy, communicating with local government officials, and consistently taking the temperature of our community when it comes to the pandemic. One of the most discouraging things about the response to this pandemic is the lack of widespread awareness of how controllable lifestyle factors can dramatically reduce the risk of severe illness and death (one of the reasons I wanted to write this article). I'll mention right off the bat that this article won't touch on the issue of vaccination. Still, the information within this article is incredibly valuable to both those that choose to be vaccinated and those that do not. Immune system health impacts not only your ability to fight off infections but how quickly you recover from them. This information also spans beyond just COVID-19 to immune health in general.

RECENT: 12-Week Conjugate Program for Raw Powerlifting

As I began searching for more information on this topic, I came across Dr. James DiNicolantonio and his book "The Immunity Fix." I first heard of Dr. DiNicolantonio when I began learning about the Vertical Diet from Stan Efferding (more about that later).

Dr. DiNicolantonio is a cardiovascular research scientist and doctor of pharmacy at Saint Luke's Mid America Heart Institute in Kansas City, Missouri. He serves as the Associate Editor of Nutrition and British Medical Journal's (BMJ) Open Heart, a journal published in partnership with the British Cardiovascular Society. He is the author or co-author of more than 250 publications in the medical literature. He is also on the editorial advisory boards of several medical journals. Dr. DiNicolantonio's books "The Salt Fix" and "The Mineral Fix" are incredible health resources from which I've learned a lot.

Throughout this article, I'll be citing numerous excerpts from "The Immunity Fix," as well as answers to questions I recently asked Dr. DiNicolantonio myself. His book goes deep into the physiological processes of immune health and the research supporting these interventions. For this article, I will be emphasizing some of the larger takeaways that particularly apply to strength athletes, such as powerlifters, strongman competitors, bodybuilders, CrossFit athletes, etc. I will also be citing my own experiences as I've navigated, addressing my health, with a couple of actionable items I'm doing myself at the end of each topic. If you find the information in this article helpful, I highly recommend checking out "The Immunity Fix" by Dr. DiNicolantonio.

As a reminder, this article does not constitute medical advice, and if you are ill or have questions about medications or interventions, you should contact your health provider. So, let's get started.

The Impact of Being Big

Many strength athletes carry a heavier body weight, which isn't necessarily a bad thing in and of itself. Dr. DiNicolantonio emphasized that "an increase in muscle increases the body's water weight, improves immune function, and metabolic health. Thus, if the calories that are being consumed are from whole, nutritious foods, having more bodyweight due to more muscle mass can be a good thing." 1

The risk is when the heavier bodyweight comes with components of metabolic syndrome and/or a highly processed food diet. We will touch on nutrition further in this article. Metabolic syndrome is defined as a condition in which at least three or more of the following are present: high blood pressure, central obesity, high fasting triglycerides, high blood sugar, and low serum HDL cholesterol.2 The impacts of poor metabolic health on COVID-19 outcomes has been eye-opening3:

  • Obese = 50% greater risk of dying
  • Obese = 2x risk of being hospitalized
  • Metabolic Syndrome = 4.5x risk of ending up in ICU
  • Metabolic Syndrome = 4.7x risk for a ventilator
  • Metabolic Syndrome = 3.4x risk of dying

These negative health impacts also extend to broader health and illness outcomes, as metabolic syndrome doubles the risk of cardiovascular disease and increases all-cause mortality by 1.5-fold.2 Studies even show that individuals with a higher BMI (body mass index) get reduced protective immune response from vaccination over time. A pro-inflammatory microenvironment created during obesity worsens the flu virus. It can lead to further complications during a viral infection (such as the "cytokine storm" that we hear about in certain COVID patients).4 Even specific metabolic issues such as diabetes have an impact on how you deal with illness, with Diabetics having a 27.7% higher mortality from COVID-19.3

If you find yourself with a number of these metabolic risk factors, I would encourage you not to feel defeated or discouraged. Instead, to be excited that even small adjustments (which we'll be discussing shortly) could begin dramatically improving your immune response.

Key Takeaways: Carrying a high percentage of body fat, and/or having other metabolic issues such as high blood sugar levels; have a dramatic negative effect on immune system health.

Action Steps: (1) Get your blood work done (2) Begin addressing body fat levels and/or applicable metabolic issues via healthier nutrition and supplementation (covered shortly).

The Impact of a Caloric Deficit

While having a higher BMI certainly carries with it the higher risks of immune deficiency, athletes who maintain a very low body fat percentage or are regularly in a caloric deficit also have factors to consider. Dr. DiNicolantonio explained that "when an athlete is in a caloric deficit to lose weight, the immune system will suffer during this time, and they will be at a higher risk for infections." 1 Suboptimal micronutrient or hormone status and increased stress (all common when tightly restricting calories) are all factors that reduce immunity.

Common deficiencies that can hurt the immune response are Vitamin D, Vitamin K2, Magnesium, Selenium, Vitamin A, Vitamin C, B Vitamins, Zinc/Copper, and Vitamin E.6 Salt is another deficiency that may surprise you, particularly with all the bad press salt has gotten over the years. Athletes who participate in strenuous exercise are often deficient in salt, and most need much more than is commonly recommended.

One of the essential minerals in salt, chloride, is also used by our body to make hydrochloric acid, helping to form stomach acid for killing pathogens and absorbing nutrients that are important for a healthy immune system.7 Sodium is also required to drive iodide into the thyroid gland, and maintaining appropriate sodium status is needed for thyroid and immune system health.17 Dr. DiNicolantonio's book, "The Salt Fix," contains a lot of great information on this topic. I will also discuss how to address some of these deficiencies when we cover Nutrition and Supplementation Strategies.

Key Takeaways: If you're restricting calories, it doesn't automatically mean your immune system is healthier.

Action Steps: Address nutrient deficiencies via a micro-nutrient-rich diet (covered shortly) and supplementation.

The Impact of Stress

Chronic everyday stress is a problem for many people, and it is one of the major contributors to an imbalanced immune system and predisposition to disease. The immune system and the brain are connected via the HPA axis and the sympathetic nervous system. The HPA axis is a major neuroendocrine system that controls stress reactions and regulates other bodily processes like digestion, circadian rhythms, immunity, mood, and sexual function.8

Getting your body out of constant fight-or-flight mode, and engaging the parasympathetic nervous system is crucial in reducing chronic stress. Breathing techniques, meditation, moderating stimulant intake, improved cardiovascular condition, time outside, and petting your dog (I'm serious) are all means of improving your ability to do this.

Brain-Derived Neurotrophic Factor (BDNF) also helps us recover from chronic stress by promoting neuroplasticity and making the brain more malleable. Ways to boost BDNF include:

  • Improving sleep
  • Optimizing magnesium levels
  • Getting additional exposure to sunlight
  • Acupuncture
  • Relaxing music
  • Exercise
  • Supplementation of Curcumin
  • Cold and Heat

Key Takeaways: Stress will run down your immune system if not kept in check.

Action Steps: (1) If struggling with mental health and stress, make an appointment with a mental health counselor, (2) Implement the sleep interventions mentioned later, and (3) Supplement with a bioavailable form of magnesium.

Nutrition Strategies for Improved Immunity

Nutrition plays a huge role in immune health and your ability to recover from illness. The standard American diet (and even common fitness diets that utilize processed foods) include many of the following that weakens the immune system10:

  • Inflammatory oils and rancid fats (Omega 6 seed oils)
  • Refined grains
  • Processed carbs and added sugars
  • Excessive alcohol

While you can certainly choose to have these things on an occasional basis, consistent intake of refined grains and processed foods can cause issues with the gut lining (such as intestinal permeability or leaky gut), and increased low-grade inflammation makes one more prone to infections.11 We know that one of the main issues in severe COVID cases is systemic inflammation12 and there is a direct connection between systemic inflammation throughout the body and the gut microbiome. The gut itself harbors up to 70 percent of the immune system.13 Consistent intake of added sugars can eventually lead to insulin resistance as well, which contributes to metabolic syndrome and increased risk of severe illness.

Omega-6 seed oils have also been shown to increase systemic inflammation and insulin resistance, and the modern diet has most people eating a 20:1 ratio of Omega 6-to-Omega 3 fats; when the healthy ratio should be closer to 1:1.14 Omega-6 seed oils are common in processed foods and cooking oils used at restaurants. Even just cooking at home can make a huge difference in fixing this ratio.

Even when eating a diet free from processed foods, there are other considerations for immune health that many miss. Many "healthy" foods have gradually been depleted of key nutrients for immune health due to farming for yield versus regenerative farming. Data from the USDA found that between 1950-1999, vitamins and minerals in 43 different crops has steadily declined. From 1975-1999, the average calcium content in vegetables has decreased by 25 percent, iron by 37 percent, vitamin A by 21 percent, and vitamin C by 30 percent. From 1940-1999, the amount of magnesium in vegetables decreased by 24 percent, in fruit by 17 percent, in meat by 15 percent, and in cheese by 26 percent.15

Stan Efferding's Vertical Diet

So all of this can leave you pretty confused with where to go next for a sustainable diet that doesn't impede performance. Over the years I've taken different dietary approaches, and there are certainly different ones that work optimally for different people based on both physiological and psychological factors. My digestive issues (cramping, bloating, and other symptoms after eating certain foods) led me to research more about Stan Efferding's Vertical Diet.

I won't go into extreme detail (as you can read more from Stan on this approach), but basically, the diet focuses on getting diverse micronutrients (that are easy on the gut) as the base of the diet; and then adding additional macronutrients through red meat and rice (the vertical part of the diet). I've liked this approach because eating low-FODMAP (easily digestible) foods has helped both my performance and my mental well-being, and it's easy to adjust how much I eat of the vertical portion of the diet to gain or lose weight. It's not a magic diet, and it takes discipline, but it addresses many of the micronutrient deficiencies and systemic inflammation issues that lead to a poor immune response.16

immunity-fix-vertical-diet
https://stanefferding.com/

Key Takeaways: Both avoiding processed/junk food, and consuming micronutrient-dense foods, has a huge impact on immune system health.

Action Steps: (1) Eliminate eating out for regular meals (2) Select a nutritional strategy like the "vertical diet", which focuses on nutrient-dense foods, and stick to it.

Supplementation

Eating a diet like the above will help address numerous nutrient deficiencies, but additional supplementation may be needed or helpful to maintain optimal immune health.

Omega-3 supplementation can help address the Omega 6-to-3 ratio, Vitamin D and K2 are important for immune health, as well as selenium, vitamin A, vitamin C, B vitamins, Zinc/Copper, and Vitamin E. Magnesium is important for every bodily process, including immunity6. Deficiencies in any of these vitamins or minerals can have a very detrimental effect on your immune system (as well as performance and overall health and well-being).

Additional supplementation of things like yeast beta-glucan, quercetin, melatonin, and curcumin can also benefit the immune system and other physiological functions. An exact supplement regimen will depend on the individual, and more on this topic is covered at length in Dr. DiNicolantonio's book.

Key Takeaways: Supplementation can help fill in the gaps that nutrition doesn't adequately cover

Action Steps: (1) Daily take an effectively dosed, bioavailable multi-vitamin/mineral supplement, (2) take a quality omega-3 supplement, and (3) Ensure adequate sodium intake by using a quality electrolyte supplement and making sure you're salting your foods.

Sleep

Sleep is incredibly important when it comes to the immune system. During quality sleep is when your body is repairing itself the most.18 Sleep affects the immune system by19:

  • Improving T-cell functioning
  • Maintaining levels of natural killer (NK) cells
  • Promoting cytokine production
  • Regulating the response of antibodies
  • ..Among a host of other functions

There are numerous ways to improve sleep duration and quality, but some great places to start are:

  • Consistent bed and wake up times – Which improve sleep onset, overall sleep quality, and recovery
  • Avoiding blue light before bed – Artificial blue light suppresses melatonin and disrupts circadian rhythms
  • Sleeping in a cooler room – 60-67 degrees (F) is a good range according to the National Sleep Foundation
  • Addressing sleep apnea or other sleep conditions – This is a common (and extremely dangerous) problem amongst strength athletes
  • Block out noise and light – Keeping the room dark and quiet will enhance sleep quality
  • Improve bedroom air quality – Opening a window regularly and maintaining fresh air will enhance sleep quality
  • Don’t drink caffeine after 2pm – The half-life of caffeine is about 5.7 hours, so drinking caffeine too late in the day can disrupt sleep
  • Eat a high protein dinner – The amino acid tryptophan gets converted into serotonin and then into melatonin
  • Get your electrolytes – Sodium restriction increases nighttime adrenaline levels and impairs sleep

Even starting a few of these habits can have a great impact on your sleep quality, and in turn, your immune health and performance.

Key Takeaways: Sleep can make or break your immune system response.

Action Steps: (1) Get black-out curtains for your bedroom (2) Use a daylight alarm clock/circadian rhythm clock in the mornings, and (3) utilize the blue light reducing functions on your phone/computer/tv to help eliminate blue light in the evenings.

Training

This readership is probably the last group that needs to be reminded about the benefits of exercise, but it's worth considering that exercising regularly has been shown to increase immune cell production, and reduce the risk of upper respiratory infections.20 The main things to consider when it comes to immune system health, are finding a balance of training enough (and in a well-rounded fashion), and not overtraining. While regular exercise improves immune system response, longer intense training sessions are shown to run down the immune system temporarily.21

Everyone's training program will differ depending on your goals, but some tips to consider to help with your immune health are:

  • Don’t neglect either strength training or cardiovascular training completely. Even if your goal/sport focuses on one, make sure you don’t let the other fall too far behind.
  • Build recovery work into your training weeks.
  • If you start getting sick, don’t train. It can take discipline to do this, but it’s worth it to rest so you can recover faster. There’s a difference between doing some walking and moving around, and trying to gut out a session at the gym.
  • Avoid over-training. Determine your goals, lay out the work needed to progress, and chip away consistently. Trying to play catch-up with unnecessarily long grueling/heavy sessions will only hurt your ability to recover and train consistently.

Key Takeaways: Intelligently programmed exercise has a positive effect on the immune system. Under or over-training, however, can be detrimental.

Action Steps: (1) Ensure strength training and cardio are both programmed at least 2 days each per week, and (2) Don't train when you're sick.

Heat/Cold Therapy

One last intervention that I want to mention is hot and cold therapy. Both have shown advantages in improving immune health, but I am going to focus most on heat therapy for the purposes of this article.

Using a sauna has been associated with numerous positive health outcomes, including lower cardiovascular disease risk and improved heart health.22 And Dr. DiNicolantonio notes that "sauna therapy has been proposed as a strategy against influenza infection since at least 1957. One study found that sauna bathing among 2,000 men reduced respiratory diseases by 27 percent and 41 percent, respectively, in subjects who had two to three or more than four sauna sessions a week compared to those that did so less than once per week. The same authors recognized a 33 percent and 47 percent reduction in risk of pneumonia, respectively. A review article concluded: Regular visits to the sauna significantly reduce the frequency and severity and influenza infections in children and adults." 22 Sauna therapy also improves insulin sensitivity, upregulates heat shock proteins, and increases white blood cell count.

Research has shown the following time-dependent effects of a sauna23:

  • 10 minutes: Sweating out toxins
  • 12 minutes: Increased heart rate
  • 15 minutes: Increased white blood cells
  • 20 minutes: Cardiovascular benefits
  • 30 minutes: Optimal heat shock protein response
  • 1-2 hours: This is too long, and can lead to excessive mineral loss, dehydration, and heat shock.

Key Takeaways: Heat therapy can have a dramatically positive effect on the immune system.

Action Steps: If you have access to a sauna, begin utilizing it two times per week for 10-30 minutes.

Conclusion

Hopefully, this has given you a sense of the incredible impact that very controllable daily lifestyle habits can have on your immune health, and give you some places to get started in taking control of your health and improving your immune response, performance, general health, and well-being. Dr. DiNicolantonio has numerous books and resources that I believe are worth checking out for more information on this topic. I also mentioned the progress I've been making in both digestive and mental health, and I may write more in detail on those topics in the future. For now, pick a few sustainable actions, and commit to them. In a world filled with variables, we cannot control, take advantage of some powerful ones you can.

References

  1. Joe Schillero Interview with Dr. James DiNicolantonio. 12/18/21.
  2. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 111.
  3. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 115.
  4. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 114.
  5. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 45.
  6. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 186.
  7. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020.Page 224.
  8. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 51.
  9. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 53.
  10. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 213.
  11. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 44.
  12. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 96.
  13. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 91.
  14. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 138.
  15. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 216.
  16. Image from https://stanefferding.com/products/vertical-diet-peak-performance-detailed-program-notes
  17. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 38.
  18. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 289.
  19. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 290.
  20. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 267.
  21. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 271.
  22. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 172.
  23. DiNicolantonio, James, and Siim Land. The Immunity Fix: Strengthen Your Immune System, Fight off Infections, Reverse Chronic Disease and Live a Healthier Life. Independently Published, 2020. Page 178.

Joe Schillero has competed in both powerlifting and strongman with an elite total in the 220-pound weight class. He has his master's degree in exercise physiology and is currently the General Manager at the Mandel JCC in Cleveland, Ohio. In this position, he oversees fitness, membership, and aquatics operations. He can be reached at joeschillero@gmail.com.