With a few small steps, you can improve immunity in just three weeks. Photo / Getty Images
With a few small steps, you can improve immunity in just three weeks. Photo / Getty Images
COMMENT:
When British Prime Minister Boris Johnson was admitted to hospital with symptoms of Covid-19 in early April, the UK feared the worst.
I had observed that a number of the Prime Minister's slim colleagues who had also contracted the virus remained relatively well, managing to cope by self-isolating at home.
This was no coincidence. It was clear to me through analysing the published research, and with my own knowledge as a doctor practising in the NHS for almost two decades, that people who were overweight and suffering from conditions associated with (but not exclusive to) obesity, were at significantly increased risk of complications and death, not just from Covid-19 but from many infections.
In early March, data from Italy, a country that had experienced high death rates from Covid-19, revealed that 99 per cent of those that had died had been suffering from at least one chronic condition. Research published in The Lancet demonstrated that 60 per cent of those that died in Wuhan, China, where the virus is thought to have originated, suffered from high blood pressure or type 2 diabetes.
What was missing from the mainstream media discussion and public health messaging surrounding the virus, was that the underlying root cause of these conditions is related to lifestyle (fuelled by the environments in which we grow, live and work) and that dietary changes alone, as my own clinical experience with patients had also demonstrated, could rapidly and substantially improve many of these risk factors.
After my comments that the Prime Minister's more severe experience of the illness was probably linked to his weight were widely publicised, Matt Hancock, the Health Secretary, asked me to provide him with more detailed evidence linking Covid-19 with obesity. But I informed him this was far from being an issue about obesity alone. It's about all the preventable and modifiable lifestyle factors that lead to an immune system that is not as resilient as it could be.
Something that gave me an even greater incentive to write my book, The 21 Day Immunity Plan, was the premature deaths of two family members who suffered and died because of a compromised immune system.
My older brother, Amit, died of a virus that affected his heart at the age of 13. Born with Down syndrome, his compromised immune system was genetic and there was little that could have been done to prevent his death from crashing heart failure when he caught a tummy bug that most people would have been able to fight off.
The second was my mother, who over the four-week period of her final admission to hospital endured indescribable pain from an infection that affected her spine. Her compromised immune system was almost entirely rooted in lifestyle choices. Because the NHS was already overstretched, a heart attack was missed, treatment was delayed and she gasped for breath as fluid engulfed her lungs. Eventually she slipped into a coma as the infection spread through her body, and she passed away aged only 68.
Beyond my observations as a medical scientist and my duties as a clinical doctor to share knowledge on the link between metabolic health and immunity, I wrote my book from the perspective and motivation of someone who has had to deal with all the emotion and sadness of seeing a close family member die well before their time and in the most horrible of circumstances. No one needs to suffer like she did and no family member should have to witness it.
What Covid-19 has also done is expose areas in our health systems and personal well-being that have long been neglected, and which in themselves have made us more vulnerable to such a particularly pernicious virus. But in spite of the tragedy, the disturbing statistics and heartbreaking stories that have collectively gripped the world, we can draw from the lessons the virus has taught us and look to a brighter future.
Dr Aseem Malhotra, author of The 21-Day Immunity Plan. Photo / Ellie Smith
The 21 day plan
The 21-day immunity plan is one that involves nutritious food, helps to regulate and reduce inflammation, combats insulin resistance and improves overall metabolic health. It should be enjoyable and be in keeping with all cultures and personal preferences.
It will help you to:
1. Lose excess body fat in a sustainable and enjoyable way, which will improve metabolic health irrespective of weight loss.
2. Support normal immune function and make you more resilient to fight infection through food, nutrition and lifestyle measures.
3. Reduce the risk of type 2 diabetes; help control blood glucose and the need for medications for those with the condition; and potentially reverse or send it into remission. Reduce high medication loads and prevent and manage heart disease.
4. Get you on the road to significantly reducing your risk of developing dementia and cancer.
Over the course of the three weeks, you will follow an eating plan, you will be required to move your body daily, carry out breathing exercises, monitor and improve your sleep habits and be seeking to reduce your stress and improve your mental well-being by making a concerted effort to nurture and celebrate time with friends and family.
Please note that if you suffer from type 2 diabetes, high blood pressure or heart disease and more specifically are taking medications, you must consult your doctor before starting the 21-day plan, as medication is likely to need adjusting/reducing and may potentially need to be stopped altogether.
Move
We know that prolonged sitting and being more sedentary in general increases the risk of heart disease, high blood pressure and type 2 diabetes.
Regular cardiovascular exercise has the strongest evidence base when it comes to reducing the risk of many diseases. It has even been shown to significantly reduce insulin resistance within three months for those who start off with a sedentary lifestyle, even without weight loss.
Throughout the three weeks of this plan, I want you to go for a brisk walk for at least 30 minutes on five days each week. Subjectively, this is where you feel a bit out of breath to the point you're able to have a conversation but you'll find it difficult to sing.
If you want to be very precise, then measuring your heart rate provides a more objective measure of activity intensity.
You want to aim to get your heart rate within a range of 50 to 70 per cent of your maximum, which is related to your age. The reason for this heart-rate range is based on numerous studies which reveal beneficial physiological changes in the body start to occur once you exercise at this level, including reduced insulin resistance.
To calculate this range, you deduct your age from 220. For example, if you're aged 40, the figure would be 180. You will need to aim to get your heart rate working at between 50 and 70 per cent of that number, which in this instance is 90 to 126 beats per minute.
If you're starting to exercise like this for the first time then perhaps start in bouts of 10 minutes per day and build up gradually over a few weeks. Listen to your body; if you start to feel exhausted, your body is telling you that you're overdoing it.
You are aiming to move as much as you can. Do not sit for more than 45 minutes at a time – take two-minute movement breaks. I suggest getting up and doing 10 squats. Take the stairs wherever possible and, most importantly, move in ways that you enjoy, whether it be dancing, cycling or even having sex.
Psychological stress is a significant contributing risk factor in up to 90 per cent of all chronic diseases but the human body and mind can quickly achieve balance and freedom from stress by using a holistic approach.
Focusing on one's breathing is one of the easiest and best ways to activate the part of the nervous system that is involved in reducing stress – the parasympathetic nervous system. Within just a few seconds of deliberately slowing one's breath, our heart rate will also slow, which is a powerful demonstration of how much the mind affects the body. I suggest you do the following breathing technique every day throughout the 21-day plan.
Choose a comfortable position that allows you to let go of any tension. Start by paying attention to where your breath is located; notice if you are breathing with your belly or using the upper chest. When you exhale, gently soften the shoulders and let go of any tension. Free up the neck with gentle micro-movements from right to left. When you feel ready, softly close your eyes and let your body sink into a deep state of stillness. Notice how your skin starts to let go of the tension too.
Gently direct your awareness towards the lower portion of your rib cage and notice the gentle sideways movement as you inhale and exhale. Focus on the softness of your breath and avoid creating resistance at the end of the inhalation. This exercise is about letting go.
If you prefer something more directed, just breathe in slowly counting for five seconds in your head, and then breathe out. Another helpful technique is to breathe in for four seconds through your nose, hold it for seven and then exhale for eight seconds. Start by doing a breathing exercise such as these for 10 minutes every day and slowly build up to 20 or 30 minutes.
Three meals per day maximum, and eating only until you feel full. Take your time eating, eat with others if you can and enjoy your food.
1. At least two to four tablespoons of extra virgin olive oil daily.
2. One small handful of tree nuts (walnuts/ almonds/hazelnuts/ macadamias) daily.
3. At least five to seven portions of a variety of fibrous vegetables and low-sugar fruits a day (see below). I suggest a maximum of two pieces of low-sugar fruit and/or one medium-sugar fruit, and at least five portions of vegetables a day. Fibrous foods tend to make you feel full for longer, reduce a rapid rise in blood glucose and insulin and are good for gut bacteria (the microbiome).
4. Vegetables in at least two meals daily.
5. Oily fish (such as salmon, mackerel, tuna, herring and sardines) at least three times a week.
1. Fibrous vegetables include cauliflower, broccoli, asparagus, aubergine, spinach, onions, peppers, Brussels sprouts, mushrooms, cucumber, celery, tomatoes and courgettes (tomatoes are technically a fruit, although most people think they're a vegetable). You can also eat these freely.
2. Low-sugar fruits include all berries, such as blueberries, raspberries and strawberries, avocados, lemons and apricots (one portion is 80g in weight; eat a maximum of two portions per day).
3. Medium-sugar fruits are apples, pears, oranges, peaches (you can eat a maximum of one per day).
Avoid
1. All added sugars, fruit juice, honey and syrups. I advise you go completely cold turkey on added sugar and sucrose (which is 50 per cent glucose, 50 per cent fructose). It's the fructose that has been shown to increase liver fat and insulin resistance when consumed in excess. Whole fruit in general is not a problem but for metabolic health do not consume too many of the high-sugar fruits, especially without regular vigorous activity.
2. High sugar fruits include bananas, pineapple, mangoes and cherries.
The World Health Organisation set an ideal maximum limit of no more than six teaspoons of added sugar, fruit juice, syrups and honey for the average adult per day. The US Department of Agriculture recommends no more than three teaspoons for the average 4- to 8-year-old child. One chocolate bar, a glass of fruit juice or a can of cola contains almost three times that amount!
3. Avoid all low-quality carbohydrates and starchy foods that lack fibre. This includes all packaged carbohydrates, pastries, cakes, biscuits, pasta, couscous and rice.
4. Avoid all grains for the 21 days of the plan because these foods, particularly rice, wheat, oats and all breads, tend to be high in starch that raises blood glucose for those who are insulin resistant. One of the best alternatives that doesn't tend to spike blood glucose is quinoa. Substitute cauliflower rice (available in most supermarkets) for rice and courgette or celeriac for pasta.
5. Avoid all ultra-processed foods. If it comes in a packet and has five or more ingredients, especially if containing additives and preservatives, don't eat it.
Intermittent fasting, or time-restricted eating, has attracted a lot of recent attention. At a very basic level, intermittent fasting allows the body to use up stored energy by burning up excess body fat. During periods of prolonged fasting, such as 16 or even 24 hours, the body switches from using glucose as its primary source of fuel to using fat in the form of ketones.
Again, although intermittent fasting may help you lose weight, a number of studies have shown that many of the benefits of intermittent fasting are independent of weight loss. They include improvements in lowering insulin, controlling blood glucose levels, lowering blood pressure, aiding abdominal fat loss and enhancing exercise endurance. In other words, fasting improves metabolic health.
For the purposes of the 21-day plan, whether you choose to fast or not is up to you and depends on where you're starting from in terms of overhauling your diet.
If and when you feel confident that you can introduce it into your daily routine, do so over a few weeks by gradually reducing the time window in which you eat from 12 hours to eight hours. What you're ultimately aiming for is to fast for 16 hours per day, i.e. for your eating window to be between 10am and 6pm; 11am and 7pm or 12pm to 8pm. During that eight-hour window I suggest you eat according to your hunger levels, still sticking with the plan to avoid ultra-processed foods and refined carbohydrates. If you feel you need to eat three meals in that short time frame, that's fine, but many people get by with two and include healthy snacks in between.
When you make this switch you may experience hunger, irritability and impaired ability to concentrate. These side effects usually disappear within a month, so don't give up too early!
During the fast you can still have as many non-caloric drinks as you like, such as water, black coffee, green tea or herbal teas. If you're stressed, I suggest you keep caffeine to a minimum.
Make an effort to increase time spent with friends and family each week. It's not only good for our mental health but helps mitigate stress too. Research reveals having meaningful relationships is the biggest predictor of happiness and is also linked to health and longevity.
Sleep
Research reveals that once you drop below seven hours of sleep a night, insulin resistance starts to increase.
The overall lifestyle changes in this plan will also lead to longer and more productive sleep.
The major cause of poor sleep is stress, so you need to find ways of mitigating your own stresses through activities such as mindfulness meditation and by taking regular moderate exercise.
Try to switch off from social media and computer screens at least two hours before bed. Avoid caffeine after lunchtime, especially if your sleep is already poor, as the stimulant effect of caffeine can continue for many hours.
What do I do after 21 days?
If it's going well and you're starting to see results, carry on! In terms of type 2 diabetes remission the maximum effect for most is seen with up to 70 days of following a dietary plan.
I have followed such a plan since 2015. I lost a stone (6.3kg) around my waist and besides needing at times to implement extra stress reduction measures, my metabolic health has been excellent.
Does that mean that I don't indulge in the occasional treat? Absolutely not. Although I don't crave ultra-processed food or sugar any more, I will still occasionally indulge in a pizza with a sourdough base, or a chicken biryani takeaway at the weekend.
If this is to become a lifestyle that you follow easily, then I advise sticking to the 80/20 rule. Follow the plan at least 80 per cent of the time and if you want a treat, such as a sweet dessert, a takeaway or a different kind of carbohydrate, such as whole grains, you can indulge in them 20 per cent of the time without feeling guilty.
