Before there was even a notable contender in the race for a COVID-19 vaccine I was already fielding questions from patients, friends, and acquaintances about the possible vaccine. It goes to show how very early on in this pandemic the decision was made to put most of our federal resources into the “vaccine search” as opposed to other options such as funding large-scale studies on treatments (both natural or pharmaceutical). As a physician, specifically a naturopathic physician, I have an express duty to understand the finer points of vaccine creation, potential responses of the system (positive or negative), and mode of action. It is also worthy of mention that I serve a diverse population of patients with a spectrum of different health concerns and conditions. I therefore find it of particular importance to understand the nuances of the science behind a vaccine, which patient populations it might be most helpful in, and any patient populations that it might be harmful for.
In this post I will be addressing the mRNA COVID-19 vaccines from Pfizer and Moderna which are currently the only vaccines with EUA approval status in the US. I will also note that I wrote this post in conjunction with my appointment to receive my first dose of the mRNA vaccine. You can scroll to the bottom of this article for my quick list of Pre and Post COVID-19 Vaccine Suggestions.
There are a few golden rules that I tend to stand by in my position as a physician and one of the more important ones is whenever possible I try out all procedures and treatments and diet recommendations on myself first. Now of course there are some things I might recommend for a patient that I have not experienced (such as a surgery, a particular type of medication, etc), but I rarely make a recommendation that I would not consider as something I would do myself if I ever needed to. This is a part of my decision to go forward right now with the vaccine. I am in a unique position in that I get comprehensive lab work-up done at least once a year so I can watch for changes or abnormalities outside of the norm; I have done my genetics so I am aware of specific risks that I hold on a genetic basis. I intend to keep my patients updated on my own response to the vaccine as I think this type of transparency is important.
Since I am set up for my first dose of the vaccine I will also be sharing in the next few paragraphs my own pre and post-vaccine prep work in the hopes that it will improve the efficacy of working with my immune system and reduce risk for potential side effects. Let’s get some big questions out of the way first.
What does the vaccine do and what does it not do?
The mRNA vaccines are given as injections in the muscle of the upper arm. Your circulating immune system cells called macrophages will be some of the first cells to pick up the mRNA and as the mRNA is incorporated into the cell the “instructions” on how to build a protein are delivered. Some key points to note about mRNA vaccine:
It does not enter the nucleus of the cell where our DNA is sequestered
It does not contain adjuvants (which are extra ingredients that have to work to “stimulate” the immune system, aluminum is a common adjuvant in many other vaccines)
It is essentially a “recipe” that tells the cell how to make a protein that will work as the antibody against a crucial part of SARS-COV-2
It does not have the ability to change our DNA
It does not cause COVID19 and does not teach the body how to make the full virus
It does contain lipid particles to coat and protect the mRNA, one of them being polyethylene glycol (PEG), which could be a problematic ingredient for highly allergic individuals.
As the mRNA vaccine provides a recipe for the immune cells, we are able to essentially bypass the time it takes the immune system to learn how to respond and fight a completely new virus if the system is infected with COVID19. The immune system, if properly enhanced by the vaccine, will immediately begin its fight against the invasion of the virus by impeding the spike protein that allows the covid virus to enter our cells and hijack them to become viral producing cells. The current Pfizer and Moderna vaccines are given in a 2 shot series to verify that the immune system gets enough repetition and exposure to make enough of the protein antibody.
With all vaccines there are other variables that also need to be considered. A big variable is the state of the immune system of the individual receiving the vaccine. Problems can arise in elderly patients who often have a less than robust immune response or in others who might be immunocompromised. There is a known and predictable decline of the immune system that accompanies aging known as immunosenescence. This results in higher rates of inflammatory related diseases and also increases in the severity and frequency of infectious disease. There is also a well known reduced response to vaccination in older adults. These situations can be where the vaccine may have less effectiveness, yet these are populations where we would prefer the most protection. For this concern I would like to discuss part of my pre and post vaccine protocol, or the “natural adjuvants” that anyone preparing to take a vaccination can consider.
Gut Health & Probiotics
There are certain ways we can interact with our own immune system to enhance the response to vaccines. We have specific studies that have been done over time already on this subject. We know for a fact that the largest reservoir of the immune system lies just beyond the walls of the gastrointestinal tract. Any system-wide immune response will have to come from this GI reservoir. Therefore we know that the health and integrity of our gut is crucial for immune response and also crucial for enhancing a response to a vaccine. Studies have focused mainly on the difference between taking probiotics directly before and then for extended periods post-vaccination. The results show that the vaccine effect is better in a patient who has been taking a probiotic supplement. To be clear, these studies have not been done with the COVID19 vaccine but have been done with the Hib, DTaP, rotavirus, polio, and influenza vaccines. The interesting finding with these studies is that the Hib, rotavirus, polio and DTaP studies were done on infants, but the influenza studies were done on elderly adults. Both showed that a probiotic administered for several days before the vaccine and then for at least 3-9 weeks after showed higher levels of antibody titers, protection rates and seroconversion rates.
Exercise
Additional research into metrics such as sleep and exercise show some ability to provide a positive vaccine response. The exercise component in the research shows particularly strong benefits for older adults. Timed exercise directly before vaccination is a researched and proven way to improve the vaccine response. The research points to cardiovascular exercise as compared to flexibility training as being the type of exercise that increases the vaccine protection and maintenance. In general, regular exercise improves immune function and improves the response to vaccination, especially in older adults. The research also discusses muscle-damaging exercise, which is a scientific way to describe weight-lifting. So from the research one could infer that doing an aerobic, cardiovascular exercise where you get close to breathlessness combined with a 10 minute weight training protocol (specifically on the arm muscles if the vaccine is going in the arm) would be a great activity to do within the 4 hours prior to receiving the vaccination. Then, if you are an older adult, maintaining a regular exercise routine for 10 months or more after the vaccination may help retain the antibody effect for longer.
Sleep
Sleep is another daily necessity that we can utilize to our advantage post-vaccination. Specifically, our levels of deep sleep enhance our immune system response. Getting adequate deep sleep within 24 hours post vaccination has been researched and shown to enhance the early stages of immune response. Not only does the sleep improve the immune response but sleep also enhances the induction of memory immune cells over the next 2 weeks. I am a big fan of tracking my sleep metrics (I am an Oura ring fanatic for this) and I encourage many of my patients to track their sleep as well. We know that as we age, the amount of deep sleep diminishes. We also know that deep sleep is the only time that the immune system repairs and regenerates. So paying special attention to your sleep metrics as you age is imperative to maintain a stronger immune system.
Final Thoughts
In summary, I will be taking the COVID-19 mRNA vaccination series and I am encouraging most of my patients to do so as well, although there are certain patient populations that may need additional support around the vaccination beyond what I am laying out in this post. I always recommend my patients discuss their individual health concerns directly with their doctor who knows their health history best. I think it is important to note that we do not currently know how long the vaccine will provide protection and antibodies against the SARS-COV-2 virus, but as the vaccines are becoming available to more segments of the population, there are natural “vaccine boosters” that we can take advantage of, such as improving gut health and function, exercise, and sleep. My hope is that as we vaccinate and give at least some length of extended immunity to larger portions of the population, it will also allow for more research to be done into more effective treatment methods, as this is a virus that will be circulating with us for years to come. We clearly need better approaches to dealing with the virus than continued lockdowns and hospital systems in crisis.
Pre Vaccine Do’s:
Probiotic supplements - starting a minimum of 3 days prior and extending at least 8 weeks beyond the second vaccine dose
Prebiotics in the diet - garlic, onions, leeks, inulin - these help to feed the good bacteria living in the gut
Reduce strain or stress on the gut = healthy diet, no alcohol, minimal sugar, minimal inflammatory foods
Acute aerobic exercise + acute muscle damaging exercise = 30 min aerobic cardio + 10 minutes of arm-specific weights within 4 hours prior to vaccination
Post Vaccine Do’s:
Get plenty of Deep Sleep the night after the vaccine dose and for 7 days post-vax - enhances the immune memory response and improves antibody response (for those in night shift jobs - try not to work the night shift directly after the vaccination)
Continue probiotics + diet with prebiotics
Maintain a daily exercise or movement protocol
Continue to wear a mask to protect others around you who have not been vaccinated
Note: The information in this post is a general overview on the thought process regarding the COVID19 Pfizer and Moderna vaccines and because it is a generalized discussion, it is not designed to provide treatment recommendations for those individuals who might be at higher risk for a vaccine side effect. This is something that I reserve for discussion in my one-on-one patient visits. I also think it is important to point out that the mRNA vaccines are entirely different from all other vaccines for other diseases, meaning what I discuss for the COVID19 vaccine protocol may be slightly different from a pre and post vaccine protocol for other vaccinations.
For more reading and other resources: