Please note: Due to the novelty of COVID-19, no peer-reviewed research has been published regarding the effectiveness of dietary or lifestyle interventions for its prevention or treatment.

As the world braces itself for COVID-19, it’s almost impossible to avoid feeling a sense of fear. While toilet paper, hand sanitizer and food fly off the shelves and public events are cancelled, many are turning to their physicians for guidance during this time of uncertainty. The Centers for Disease Control and Prevention (CDC) guidelines for limiting exposure (social distancing, handwashing, wearing a mask, etc.) are excellent ways to decrease contact with viral threats. While this information is helpful there are still a lot of unknowns, which can create anxiety. Most have seen the “keep calm and wash your hands” gif created by the CDC, but the majority of people have disregarded a key component to this message. Keeping calm is one of the best natural defenses for immunity.

As a functional medicine provider, I know that the health of the stress response system, officially called the hypothalamic – pituitary – adrenal, or HPA axis, plays an important role in immunity. Comprehensive cortisol and stress hormone testing is a valuable tool for evaluating HPA access health, and can play an important role in evaluating one’s physiological preparedness to weather this pandemic.

The HPA axis orchestrates a symphony of actions when an individual encounters stressors. It’s important to note that stressors can be different things to different people. While most think of external things like deadlines or arguments as stress, internal stressors like food intolerances or perceived threats – real or imagined – can also activate the stress response. The HPA axis is designed to handle short term stress. Once activated, an immediate release of the neurotransmitters epinephrine and norepinephrine occurs. This surge enables us to get away from the threat. Next, cortisol spikes to control metabolic processes necessary to keep the individual moving away from the threat. This concept has been described as “running from the tiger,” the tiger being whatever stress one is encountering. Once the threat resolves, the HPA axis downregulates these signals and the individual returns to a balanced state. This response is a normal, healthy part of life. But what happens if no matter how hard or long an individual runs, the tiger always seems to be there, as the case seems to be for many living in the modern world? The HPA axis begins to show signs of dysfunction and can set up a host of health conditions including chronic inflammation, disrupted circadian cycles, and increases in mental health concerns. Dysfunction of the HPA axis can also lead to decreased immunity – very worrisome in light of the current pandemic.

Cortisol plays an important role in the development of immunity by influencing the release of cytokines which are signals from one immune cell to another. During an initial viral challenge, cytokines mediate the immune response via pro-inflammatory cytokines and the activation of immune cells. In addition to contributing to the development and progression of immune cells, the HPA axis exerts a negative feedback mechanism to suppress immune cell overproduction which can contribute to tissue damage. It is through this process that Ibuprofen has been suggested to be potentially harmful to take if one has a COVID-19 infection because it affects cytokine and inflammatory response production.

Adaptogenic herbs, aptly named for their ability to help modulate the stress response, might be an important addition to your antiviral alternative medicine arsenal. This class of herbs not only works to boost the HPA axis, but many also have immune-boosting properties. Astragalus can reduce inflammation and increase the immune response during viral exposure. Licorice root, an herb with a long history of use to support HPA axis health, has been shown to inhibit SARS-coronavirus in lab settings. But herbs aren’t the only modulators of HPA axis health with antiviral properties. Inflammatory markers have been linked to depressive symptoms and acute psychosocial stress. Mindfulness meditation, a common treatment for those with HPA axis dysfunction, has also been shown to modulate immune function of inflammatory cytokines. Cognitive behavioral therapy (CBT) has been shown to improve symptoms of depression and anxiety and may also play a role in modulating inflammatory markers associated with the chronic stress response.

As a functional medicine provider, I have many tools to help individuals feel better prepared for the unknowns of the COVID-19 pandemic, both physiologically and emotionally. Evaluating HPA axis preparedness via cortisol testing is a logical place to start optimizing the stress response which can contribute to a balanced immune response and a prepared mental state. Adaptogenic herbs and lifestyle strategies such as meditation and CBT can also contribute to a healthy HPA axis and immune response.

You can learn more about the comprehensive stress hormone test I offer here. You can also support a local small business and your immune system by purchasing immune boosting and adaptogenic natural supplements through my online natural dispensary.

In good health,

Dr. Wehling

References:

1. Silverman MN, Pearce BD, Biron CA, Miller AH. Immune Modulation of the Hypothalamic-Pituitary-Adrenal (HPA) Axis during Viral Infection. Viral Immunology. 2005;18(1):41-78. doi:10.1089/vim.2005.18.41
2. Block KI, Mead MN. Immune System Effects of Echinacea, Ginseng, and Astragalus: A Review. Integrative Cancer Therapies. 2003;2(3):247-267. doi:10.1177/1534735403256419
3. Hoever G, Baltina L, Michaelis M, et al. Antiviral Activity of Glycyrrhizic Acid Derivatives against SARS−Coronavirus. Journal of Medicinal Chemistry. 2005;48(4):1256-1259. doi:10.1021/jm0493008
4. Thibodeaux N, Rossano MJ. Meditation and Immune Function: The Impact of Stress Management on the Immune System. OBM Integrative and Complementary Medicine. 2018;3(4):1-1. doi:10.21926/obm.icm.1804032
5. https://www.ncbi.nlm.nih.gov/pubmed/31634750
6. https://journals.sagepub.com/doi/full/10.1177/0004867417701996

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