Like many physicians, I have been following the daily United States Centers for Disease Control and Prevention (CDC) updates about the recent coronavirus outbreak. Three facts seem to recur throughout these reports: 1. Most cases of the coronavirus disease 2019 (known as COVID-19) are mild and not life-threatening. 2. The coronavirus is not predictable in the way it spreads. 3. The coronavirus is not and likely will not be contained for quite some time. According to the latest CDC report, posted five minutes before I wrote this very paragraph, “preliminary data suggest that older adults and persons with underlying health conditions or compromised immune systems might be at greater risk for severe illness from this virus.”
It is not surprising that words like these elicit anxiety, fear and panic. Patients and friends have asked me what they can do to be prepared when the inevitable, unpredictable and uncontainable coronavirus reaches our neck of the woods. Aside from recommending handwashing and avoiding crowds, my answer might be surprising.
A clue lies in that very idiom, “our neck of the woods.” There was a time, a little over a century ago, when people actually lived in various necks of the woods. Is it a coincidence that the COVID-19 outbreak started in Wuhan, China, where the population density is approximately 3200 people per square mile, according to the World Population Review website? Were people intended to live in such densely packed conditions? Aside from the ease of viral transmission provided by people living so closely together, what other factors might predispose people in overpopulated cities to become ill? What if the answer to these questions lies right outside our windows?
Each of us has an immune system, comprised of various organs and millions of cells designed to defend against all manner of daily insults, including bacteria, fungi and viruses. In a nutshell, things that we do or do not do in our daily lives determine the effectiveness of our immune system. It really is that simple, and even applies to those with immune system disorders.
So how can we strengthen our immune system? Give it sleep and physical exercise, reduce stress, eat lots of vegetables, avoid toxic insults such as alcohol, tobacco, pesticides, parabens, phthalates and plastics, but most of all. . . take it OUTSIDE. Here’s why:
- Vitamin D. Vitamin D is produced in the body when the sun’s ultraviolet rays contact the skin and initiate a chain reaction converting a form of cholesterol into Vitamin D. Vitamin D has been found to have many effects in the body, one of which is maintaining a healthy immune system. In fact, Vitamin D deficiency in childhood is associated with increased risk of autoimmune disorders, such as Multiple Sclerosis (MS), in adulthood. Individuals who live in climates where there is little sun exposure or who spend most of their time indoors are at significant risk of Vitamin D deficiency. A blood test can determine one’s Vitamin D level; > 50 ng/ml is considered optimal. Recommendations are to supplement Vitamin D if one’s level is suboptimal and/or to strive for 15 minutes of mostly unclothed sun exposure per day, ideally mid-morning, in climates where this is possible.
- Phytoncides. These volatile organic compounds have been identified in plants. They serve to protect the plant against invasion by bacteria, fungi and viruses (sound familiar?). Studies have found that when people spend time in nature that they inhale these phytoncides, which work to improve immune function in humans as they do in plants (Li et al., 2006, 2009).
- Mycobacterium vaccae. This microorganism, located in soil, has been found to activate the immune system in animal studies. It is believed that when people spend time outdoors, getting down to earth, as it were, these microscopic bacteria are inhaled and ingested, contributing to one of the many immune-boosting properties of nature (Lowry et al., 2007).
- Central Nervous System effects. A significant amount of research has looked at the mental health benefits of time spent in nature. (See the excellent review articles by Dr. Margaret Hansen in 2017 and Dr. Ming Kuo in 2015 for specifics.) Emerging evidence has revealed a correlation between low-stress, “parasympathetic” tone and immune system stimulation (Kenney and Ganta, 2014). In other words, our immune systems are happy when we’re It does not take a huge stretch of the imagination to correlate the high-stress environment of overpopulation with diminished immune system function.
- Natural Killer (NK) Cells. Qing Li, one of the physicians in Japan who coined the term shinrin-yoku, or forest bathing, has studied the effect of time spent in nature upon NK cells. These cells, whose job is to sweep through the body to locate and eliminate tumor cells, viruses and bacteria, have been found to increase in both number and level of activity after spending a minimum of two hours in nature (Li, 2007, 2008, 2010).
- Herbal Medicine. Certain plants have been used throughout the ages in traditional cultures to bolster the immune system. Elderberry, astragalus, and echinacea are among those that have evidence to support their use, under the guidance of a trained integrative physician, clinician or herbalist. As with all ingested supplements, quality, dose, and potential drug-herb interactions are important considerations.
I prescribe nature to my patients on a daily basis. Sometimes it is hard to believe that something so simple–so primal–as stepping outdoors can be healing. Even Hippocrates said, “Nature itself is the best physician.” It might be difficult to imagine a daily dose of nature for busy people who lack the luxury of a nearby forest, but a trending concept is that of “everyday nature,” meaning, essentially, take what you can get. Take a walk outdoors in any setting. Enjoy a “sit spot” near a single tree.
Studies show health benefits from having a window with a view of a tree (Ulrich, 1984) and even from spending time with a potted plant (Grinde and Patil, 2009). Adding natural elements to paved school playgrounds has also been found to improve children’s health (Bell, 2008). Believe it or not, even gazing at nature-themed artwork can boost attention and minimize fatigue (Tennessen and Cimprich, 1995). All these actions are likely to improve immune function either directly or indirectly.
An ounce of prevention is worth a pound of cure, and a strong immune system is the key to prevention. So, hug a tree and hold on for the ride. Believe in the medicine of nature. In terms of the coronavirus, it may be awhile before we’re out of the proverbial woods.
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