Friday, April 17, 2020

Fitness Is... Getting Sick

Fitness Is…

Getting sick.  And recovering.

A while ago I interviewed a doctor who posed me a singular question to help me understand the body and its immune system. 

“What happens,” he asked, “when you get a splinter in your finger and you don’t pull it out?” 

“It gets infected,” I responded.

“Right,” he said. “The skin gets red and the body produces puss.  Why do you think it does that?” 

“To… get rid of the splinter,” I answered, cautiously.

“Exactly. It produces the puss to extricate the splinter. Now, the important question.  Which is the illness… the puss or the splinter?”

The point he had so elegantly made was that most of us think about sickness completely backwards.  We see someone wipe their nose or have diarrhea, and we think those are the elements that need to be fixed in order to regain health.  In reality, those symptoms are the body’s way of FIGHTING whatever it is that infiltrated it. A fever is the body raising the temperature to kill an infection.  A cough is the body expelling foreign chemicals or toxins from the lungs. If the splinter is the cause of the infection, why spend our time trying to stop the puss.  Or the cough. Or the fever.

He went on to explain to me that the body actually has two immune systems.  The first, known as the cell-mediated system, is the one responsible for fighting the infection on the front lines. This is where the body sends white blood cells to the affected area to consume infected cells and expel them via snot, puss, mucus, whatever.  The second, and far more flashy system, is the antibody system. This is where our body creates an imprint or memory of a specific illness in certain cells, to more efficiently fight that illness in the future. This is how we develop long term immunity.
“The trick,” he said with a smile, “is that these things are intended to work in tandem. Without the cell-mediated response, the body isn’t capable of developing the exact antibodies it will need in the future. This is why vaccines don’t produce the same level of immunity as contracting the actual disease… the body didn’t go through the entire process of fighting off the infection.”

The realization for me at that moment was major.  What I had previously understood as “sickness” (meaning the symptoms) was not only natural, it was necessary. Without going through the process of fevers, congestion, etc, my body wouldn’t get the “reps” it needed to build a robust and intelligent immune system.  I had been demonizing my body’s natural defense mechanism against the billions of pathogens, microbes, and bacteria that exist in the world. What good was all the organic, gluten free food I was eating to fill my body with the vitamins and nutrients it needs if every time my temperature went above 100 I took a pill.  That’s like mobilizing for an hour every day but never lifting a weight. Technically you’re always ready, but you’ll never be strong.  

The cost of this misunderstanding is enormous, and twofold.  

First, when we strip ourselves of the opportunity to defend against a whole host of maladies, we increase the likelihood of sustained toxicity or infection in the body.  Remember that every fever, cough, and runny nose is the cell mediated system trying to rid your body of some abnormal or toxic element. If it is no longer allowed to do this because we took some anti-symptomatic medicine, we may be trapping the toxic element inside our cells.  

For example, the worst thing you can give a smoker is a cough suppressant… you’re removing the best chance they have to get the tar out of their lungs.  Such blunting of the cell mediated system over the course of a lifetime leads to a) an unpracticed response team living in b) a perpetually toxic environment.  Combine that scenario with a medical establishment that loves doling out antibiotics and antivirals like Halloween candy, and it’s like putting a rookie SWAT team in the yard of a maximum security prison… not a great recipe for long term health and sustainability.  In cases of extreme toxicity, the body will resort to quarantining certain areas of abnormal cells, barricading them off from the healthy tissues while it figures out what to do next. This is called cancer. 

Granted, smoking is an extreme case of acute toxic poisoning.  There are a host of other instances where the outcome isn’t so obviously harmful because our body is pretty ingenious at finding ways around the obstacles we present it.  But we also need to remember that we live in a world where even our most basic interactions with the environment are growing increasingly toxic. The air we breath, the food we eat, the radio waves we live amongst; all of it is consumed, filtered, and dealt with on the cellular level.  When we establish a practice of blunting our body’s most basic defense mechanism against these things, the garbage is going to start piling up. Enter a malignant bacteria or a novel coronavirus, and you might find yourself in a dumpster fire. 

The second cost of misunderstanding sickness is cultural.  Rather than viewing symptoms for what they are (natural and necessary), we see them as something to avoid.  Something to fear. Think of the old NyQuil slogan: “the nighttime, sniffling, sneezing, aching, coughing, stuffy-head, fever, so you can rest medicine.”  It shifts your focus away from what’s happening in your body (fighting something off) to what those symptoms are preventing you from doing (getting sleep).  Pretty clever marketing, but we eat it up. We dread the common cold, we scamper to CVS every fall to get the latest flu shot. Why? Because, heaven forbid we get sick.  Heaven forbid we miss work or school, or have to lay in bed for a few days while our friends are at the gym. It speaks to the broader impatience that has infiltrated every aspect of our lives, where we expect immediate relief from annoyance, disturbance, and discomfort. We are spoiled. We are soft.  

Instead, we rely on medicine to control symptoms and upon a sterile world to prevent infections.  A world, I will remind you, that is less sterile than it has ever been, regardless of the gallons of hand sanitizer we bathe it in. We are progressively unequipping ourselves to handle even mild infections, and, more generally, we are off-loading the responsibility for our health.  We demand a treatment for everything, a vaccine for everything. We grow unacquainted with illness, and begin to fear it in all forms. There is no perceived risk to chronic lack of self care, because it’s no longer a personal responsibility. Health is now a collective responsibility. We think that by preventing people from feeling symptoms we are protecting them, but really we are weakening them.  Day after day, year after year, we are giving them fish. But where are the fishermen?

There has never been a better example of this phenomenon than the Coronavirus pandemic. The models from every country experiencing this thing have shown, more or less, the same result: it is HIGHLY contagious and RARELY fatal.  The CDC has published findings that only about 20% of the exposed population show symptoms that would prompt them to go to the hospital and get tested. That means that the 646,000 confirmed cases in the United States actually reflects closer to 3.2 million exposures.  That means the 28,000 total deaths equates to a fatality rate of about 0.007, or a little more than half a percent. The same calculation applied to New York (the worst area of infection) puts the local death rate at exactly 1%.  

Now, in gross numbers that’s still a lot of people dying... hence the response from world leaders and public health officials.  In viral terms, it’s about 7 times as deadly as what we deal with every year during cold and flu season when massive amounts of people get sick.  In the United States alone, the CDC estimates that influenza has resulted in between 9 million – 45 million illnesses, 140,000 – 810,000 hospitalizations, and 12,000 – 61,000 deaths annually since 2010.  That’s a death rate of 0.001, or about a tenth of a percent.  

In an effort to save lives, infectious disease experts around the world immediately honed in on who COVID-19 was killing and discovered that the disease seemed to predominantly attack the elderly and infirm.  99% of fatalities in Italy had 2 or more pre-existing conditions, or comorbidities.  These are chronic conditions like diabetes, obesity, hypertension, emphysema, age, etc.  The same criteria has applied to 95% of deaths in New York. What does this mean? It means that, while the illness is not harmless to the young and healthy population, it usually is not deadly.  But it is extremely deadly to the sick, frail, and elderly. Do we know what else is extremely deadly to the sick, frail, and elderly? Not to sound callous... but almost everything. Any sort of trauma. Complications from surgery. The flu. These are high risk populations living in a world full of risks.  This shouldn’t be news to anyone.

This information is critical to understand because it highlights how we, as a society, naturally function.  In so many cases, it’s the role of the strong to shield the weak from many of the risks they might otherwise encounter.  This is no exception, but the way we’ve been directed to do so in this case is misguided. The way the strong can protect the weak from something like the coronavirus is by going out, getting sick, and getting better.  Period. Those with pre-existing conditions quarantine at home while the rest of the population goes out and lets their immune systems do the work of establishing herd immunity. Hospitals should cancel elective procedures to prepare for a surge of cases, but since the population that would ultimately need the intensive care is locked up in their houses, those beds will remain largely empty.  We know this works because it’s the way respiratory viruses work every year. The virus runs its course when enough of the population has encountered it, dealt with it, and developed immunity. By sheltering the entire population in place we are preventing the strong from encountering the virus and prolonging the life-cycle of the pandemic. This increase in time duration actually raises the likelihood that it will eventually run across someone in the at risk population before it’s done.

So, how would this have looked if we hadn’t sheltered everyone?  Look at the five US states who didn’t do so: Arkansas, Iowa, Nebraska, North Dakota, and South Dakota.  If you compare them with other states that have a comparable population density (Oklahoma, Colorado, Nevada, New Mexico, and Montana) you’ll see increased growth rates for the disease in the non-shelter states (Iowa 9% vs Colorado 6%, Nebraska 10% vs Nevada 6%, for example). However, the average death rate of confirmed cases in those 5 non shelter states is 2%, compared to almost 4% in the sheltered states.  That means that the disease is infecting people at a higher rate in the states that are not sheltering, but killing people at a lower rate. This is because the increase in infections is almost certainly born by the healthier population. People that know they are at risk are going to stay sheltered regardless of the order. These states are not reporting any issues with their hospitals being overrun and their economy hasn’t skipped a beat.  What they are achieving, is a fast track toward herd immunity.

Another example of how a non-shelter plan might’ve looked could be found right here in California if we rewind the tape a few months.  A new study being conducted at Stanford University is investigating the possibility that an early wave of coronavirus hit the state back in November, December, and January when many residents reported harsh flu symptoms. "Given the state's unprecedented direct air access to China, and given its large expatriate and tourist Chinese communities, especially in its huge denser metropolitan corridors in Los Angeles and the Bay Area, it could be that what thousands of Californians experienced as an unusually "early" and "bad" flu season might have also reflected an early coronavirus epidemic, suggesting that many more Californians per capita than in other states may have acquired immunity to the virus." It might explain why California, a state with 40 million people, has seen the same number of cases as states nearly a quarter its size in Pennsylvania and Illinois. If this turns out to be true, California would have unwittingly developed a level of herd immunity without a noticeable uptick in deaths, hospitalizations, or demand for protective equipment.  It did so, however, with a noticeable lack of hysteria, facemasks, and social awkwardness.  

But you need to have a population that is willing and able to be sick in order for this to work.  Going back to our cultural fear of discomfort, we know that if given the choice, no one is going to sign up for that job.  2 weeks of symptoms for a lifetime of immunity? We’d rather hunker down for 12 months and wait for a vaccine to shield the strong and the weak all at once.  Nevermind that this disease is something that nature is already proving it can manage. Nevermind that doctors have found effective ways to treat critical cases with drugs and methods we already have on hand.  Even the strong and healthy would rather take the risk of bankrupting businesses and increasing personal debt than they would of getting sick.

On the other hand, there’s the possibility that our population is already so sick and frail that we wouldn’t be able to handle it even if we were willing to try.  It’s true that California also happens to be one of the fitter populations in the country on average, and the natural method of combating viral infections works best when you have a population that is made up of healthy people.  If we look at just one of the pre-existing conditions that negatively impacts outcomes from the coronavirus (obesity) we see that, as a whole, we may have a problem. According to the most recent Behavioral Risk Factor Surveillance System (BRFSS) data from September 2019, adult obesity rates now exceed 35% in nine states, 30% in 31 states and 25% in 48 states. Mississippi and West Virginia have the highest adult obesity rates at 39.5% and Colorado has the lowest at 23%. That’s right, the LOWEST obesity rate in any of the 50 states is 23%. 

A study done in 2014, conducted by an international consortium of researchers led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, looked at obesity AND overweight populations (BMI of 30+ or 25-30) and estimated 160 million Americans fall into one of those two categories. Nearly three-quarters of American men and more than 60% of women qualify. Sadly, it’s not just the adult population – nearly 30% of boys and girls under age 20 are either obese or overweight, up from 19% in 1980.  Now, we all know BMI is an imperfect measuring tool, but 160 million people is a disgustingly high number, no matter how you slice it. And that’s data from 6 years ago.  

This means that the percentage of people we have walking around this country that would qualify as “low risk” is somewhere around 70%.  And that’s only if we consider obesity. Add in the non-obese who have conditions like diabetes, hypertension, heart disease, those coming off cancer treatments, and anyone who smokes cigarettes, and you see where this goes.  The “strong” among us who would be tasked with taking on the virus and developing immunity are woefully outnumbered by the “weak.” 

The sad part is that so many of these conditions are magnified by our own sedentary and malnutritious choices.  In his “Five Buckets of Death” lecture, CrossFit CEO Greg Glassman shows that chronic diseases like the ones mentioned above account for 80% of deaths annually in the U.S., whereas microbial, genetic, traumatic, and toxic events combined account for a mere 20%.  The difference between the bucket holding the 80% and the ones holding the 20% is that we have a measure of daily control over our risk level. He calls it “the willful divide.”  

Through our own actions and ignorance, we have built a society incapable of dealing with even a mild public health crisis, let alone a major one.  We progressively poison ourselves with genetically modified foods, trap ourselves indoors staring at computer screens, suppress our immune system’s natural efforts to expel every toxin, and demand that our medical community come up with a solution for the mess we’ve made.  We think that bacteria and viruses are monsters that viciously attack us and our way of life. The truth is that our way of life invites destruction. Louis Pasteur, the father of germ theory, said, “The microbe is nothing, the terrain is everything.”  Fix the terrain and you fix the problem. Build a society of strong, healthy people and you have an army of well equipped immune systems to handle almost anything nature produces.  Continue to sit at home, eating empty food, and suppressing symptoms; you have a herd waiting for a plague to strike it down.  

In spite of everything we are doing to undermine the natural process of health and immunity, nature is still finding a way.  We are still beating this pandemic, even in places where no stringent mitigation strategy is in place. After all, the body wants to heal. It adapts, learns, and overcomes better than anything ever grown in a lab.  In most cases, we just need to get out of its way. If we start embracing sickness as part of the adaptive process and stop trying to skirt the momentary discomfort it entails, we put ourselves in a far better position to protect our society long term.  Combine that philosophy with exercising regularly, spending copious time outside, and eating real food, and you produce a population that will experience life in a natural rhythm rather than a state of constant fear.