Preparing for COVID-19 with IBD

As the COVID-19 virus pings closer and closer to home we have been running through all the questions,

What should we cancel (answer: as much as possible)?

What happens within our kids who are at college?

Maybe more importantly, what happens if we are all stuck at home together?

And, how do we keep Joshua from getting sick?

Having an immunocompromised person in the house adds another level of complexity to an already stressful and confusing situation. Despite my Crohn’s being in deep remission for a year, I am at higher risk for a more serious response to the virus. Additionally, my monthly Remicade infusions (medication blocking the inflammation response and lowering immunity) make me more vulnerable to serious complications, like respiratory infections. I don’t feel overly worried about getting sick — sick has been a reality for a long time — I feel more obligated to do my best to not be a burden on the health care system, as I am much more prepared than many who are actively suffering with Crohn’s or Ulcerative Colitis.

How do you prepare your life for COVID-19 with a compromised immune system?

I think it is important to point out there are no known hacks or protocols that are going to prevent you from contracting the COVID-19 virus. Anyone who is telling you to take high amounts of whatever vitamin or some tincture and you’ll be good, is irresponsible at best. The only real preventative measure we can take to limit the likelihood of being exposed is basically staying away from places where you would have direct contact with other people or indirect contact through door handles, tables and chairs, et cetera. Adjacent to that approach is good hygiene, hand cleaning, avoiding touching your face and the like.

The world around us is starting to help make this kind of isolation easier by canceling pretty much everything, including the start of the MLB baseball season, which may have me more depressed than the idea of getting the virus. Avoiding COVID-19 gets more complicated when I think about our kids’ risk of exposure and bringing it home from high school and college when their schools close down or come home for spring break. Each body in the house increases the odds of infection significantly and with several near adults in the house, our health and sanity is at stake.

COVID-19 and IBD

Right now, it looks like there haven’t been any reports of patients with IBD contracting COVID19, according to an article in the Lancet posted on March 11th. These seems due to extreme precautions taken by the Chinese health system, but we can expect the virus to have a more serious impact based on other immunocompromised populations. Recommendations from that article include,

At home immune support

I’m expecting to get COVID-19 at some point, so I am more focused on increasing a healthy immune response when the time comes. Immune support starts with healthy food, so I am cooking frequently with garlic and ginger, as well as herbs and spices (known to be protectors of our immunity and increase the bioavailability of nutrients). I am also eating prebiotic foods such as artichokes, cassava, Brussels sprouts, and cooked-and-cooled jasmine rice and potatoes. The prebiotic foods will help to keep your gut lining and bacteria levels healthy. I don’t eat much in the way of fermented foods as I typically feel better eating prebiotic-rich foods, but I do have some kimchi in the fridge that I made a while ago. The COVID-19 virus is believed to not fare well in heat, so feel free to toast your fellow isolationists with lots of warm bone broth and teas high in polyphenols like green tea, matcha, and pu erh.

An apple a day

It is estimated that as much as 90% of our immunity is in the gut, so keeping flares down should be a top priority for anyone with IBD, however that works best for you. Long-term use of corticosteroids may increase risk of severe reaction based on some of the doctor information from China. One of my most important inflammation hacks is eating a cup of stewed apple (blended with peel and all) with cinnamon a day. The pectin and polyphenols activated primarily from the peel has been shown to reduce inflammation with a similar effect as 10mg of prednisone. Apples protect the intestinal tissues from inflammatory damage through gene regulation of NF-kappaB proinflammatory genes, enzymes, and transcription factors (source, source). Pectin from the apples can increase short chain fatty acids (butyrate) and may increase microbiome diversity, making apples pretty much the perfect intervention for IBD (source). Anecdotally, I have given this tip to people with gut issues, arthritis and shoulder injuries with great reported effect.

Ketones

There is some evidence to suggest that having ketones in your blood from a low-carbohydrate diet offers protection from the influenza virus. This is controversial data, primarily because the experiment was done on mice, but one of the well-studied benefits of a ketogenic state is healthy immune and metabolic regulation, so on an n=1 basis, being in ketosis should prove to be a benefit. More interesting is, could exogenous ketones (ketones that you drink) offer the same kind of protection? In my experiments over five years with ketones and ketosis, I think drinking a serving of a GoBHB-based ketone blend (or the ketone esters from HVMN if they were available) daily would provide benefits, even beyond the immunological implications (study analysis). I have been fasting from sun-up to sun-down for the last 11 days, and have a pretty steady 2+ mmol level of ketones, so I’m not drinking ketones right now, but I typically have them on hand for training.

Exercise

I think one of the most underrated things we can do in a time of hunkering down is actually getting outside. Go for a bike ride, walk in nature, trail run or any other sort of individual (or couple) exercise away from other people. The COVID-19 virus is primarily transmitted from person-to-person contact within 6 feet (source: CDC), so taking the time to enjoy moving will not only keep you healthier but probably help you maintain your sanity. I have been training for the last 10 weeks to run a half marathon, so I have been out almost daily on runs. You will be amazed at what even 30 minutes can do for your mood and sense of agency.

Reading is also a great activity for the home-bound and I would highly recommend Kelly McGonigal’s The Joy of Movement: How Exercise Helps Us Find Happiness, Hope, Connection, and Courage.

Meditation

I could go on for a long time about how much my four-year meditation practice has benefitted every aspect of my health and well-being. 30 minutes a day seems like a lot, but if you are spending most of your time at home, taking that time to sit with yourself will pay off big dividends for you and everyone around you. There are a ton of meditation apps out there, I recommend the Insight Timer app for the amazing content, flexible features, and courses.

The emotional roller-coaster of a pandemic on a family with members who are at higher risk can not be overstated. The fear of being exposed is hard to escape — and one of the reasons I sat down to write this post — but the benefits of a meditation practice can provide significant relief. Tim Ferriss just released an amazing podcast episode with one of my favorite meditation teachers, Jack Kornfield, called, How to Find Peace Amidst COVID-19, How to Cultivate Calm in Chaos.

Supplements

I haven’t changed my daily regimen much from my training protocol, but I have made a couple of additions and imposed them on my family to keep our family biome up. Here is my current list,

That’s my strategy, it pretty much looks like what I do daily to stay in remission, plus some good immune support and staying home more. Mostly it is being mindful of my own health, how my actions affect others (and their actions affect me) and outwardly, how our collective diligence could spare a health care overload.

If you are looking for more good info on health and COVID19, check out this podcast with Dr. Andrew Weil and Kevin Rose or this Joe Rogan episode with Michael Osterholm, an expert in infectious disease epidemiology. If you want to do a quick nerd out, watch this video, posted originally on Instagram with Dr. Peter Attia, talking about why he is concerned about this virus.

If you have more questions about staying healthy with IBD through this time, please send me an email at josh at gotostepone dot com.