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Lifestyle can have a profound effect on health, wellness, immune function and longevity. I have seen and heard of patients with cancer, obesity, diabetes, hypertension, arthritis and even dementia heal themselves and get off their medications solely using radical lifestyle change. So it is unsurprising that there are many lifestyle factors that can beneficially modulate the body’s response to COVID-19. 

Obesity is common in people who lead unhealthy lifestyles and is associated with poor outcomes in COVID-19. Obese individuals are more likely to suffer severe symptoms of COVID-19 and be hospitalized — they are also more likely to die from COVID-19. It is unclear what mechanisms drive the severity of COVID-19 in obese individuals, though it is known that obese individuals have impaired immune systems and increased inflammation, both of which are associated with severe COVID-19.

It is not just obese individuals who have a higher risk of severe COVID-19 — people who are simply overweight also have a higher risk of severe COVID-19 symptoms. Tied to weight, diet may also impact the body’s response to COVID-19. A study found that a diet high in plant based fiber, such as fruits and vegetables, was associated with lower risk and severity of COVID-19. 

Another study found that people who follow plant-based diets and pescatarian diets have a lower risk of moderate and severe COVID-19 than those who follow a low carbohydrate and high protein diet. However, it is difficult to tease diet apart from other elements of a healthy lifestyle, such as exercise and weight, so these studies may have confounding variables.

Recently, a group reported that diets rich in fermented foods may be associated with less severe COVID-19. While this is only one study, another study from Stanford found that fermented foods decrease markers of inflammation, which could support the findings of the previous study.

In addition to diet, other lifestyle factors like sun exposure and vitamin intake may impact the severity of COVID-19. Early on in the pandemic, several studies suggested that vitamin D might improve COVID-19 symptoms. Many studies have investigated the impact of vitamin D on COVID-19 patients, which has enabled other researchers to do large-scale meta-analyses. 

One such analysis found that patients with lower vitamin D levels exhibited an increased risk of developing acute respiratory distress during COVID-19 and had a higher likelihood of being hospitalized. On the contrary, another analysis observed no improvement in COVID-19 outcome of hospitalized patients treated with vitamin D. Moreover, they found no increased mortality of  patients with low vitamin D levels. 

Another small study treated hospitalized COVID-19 patients with a high dose of vitamin D and found no decrease in hospital stay with treatment. Secondary outcomes did not reach clinical significance, but there was about half the rate of mechanical ventilation in the vitamin D group 7% vs 14%, with a p value of 0.09. A larger study would have provided better data. 

Overall, it is still unclear whether vitamin D can improve COVID-19 symptoms or outcomes and further investigation is necessary. However, given the safety of vitamin D supplementation, and its known beneficial effects on immune function, it is hard to argue against its use, or even just normalizing patient levels of vitamin D, just in case it might benefit.

Other studies have investigated lifestyle quality in general, taking into account body mass index, diet, and physical activity. One such study found that an overall healthier lifestyle is associated with better COVID-19 outcomes. Another study found that physical inactivity, smoking, obesity, and excessive alcohol consumption were all associated with more severe COVID-19.

Overall, a healthier lifestyle contributes to better COVID-19 outcomes and in any case even if we don’t yet have specific data related to COVID-19 for all elements of healthy living there is no downside to implementing changes that have been shown to positively impact health in general like: having purpose and meaning in your life, maintaining close personal relationships, managing stress, eating right, exercising, sleeping enough, getting adequate sunshine, normalizing vitamin levels, finding and resolving underlying chronic inflammation/infections, and avoiding and/or removing toxins. 

You can find more in depth articles on the subject of lifestyle medicine in the Real Health section of the blog.