How Nutrition May Improve Covid-19 Outcomes

As a functional medicine nutritionist, my approach to using food in the place of medicine, or as an adjunct to pharmaceutical interventions, comes from a deep understanding of the body and what it needs to function optimally to restore and maintain health. A "functional" perspective looks at the complex interconnections between nutritive foods (and the substances within foods) and their ability to impact the biochemistry of the body, and thus change the "terrain" through which illness and disease manifest itself, with the goal of restoring health. This approach is based on the fundamental principles of orthomolecular medicine, a concept defined by Nobel Prize winner Linus Pauling back in 1968, which includes altering the concentration of substances normally found in the human body and which are responsible for the maintenance of health.

When I read a recently published, peer reviewed manuscript published in the International Journal of Molecular Sciences, I was intrigued by the authors' functional approach to the novel coronavirus, covid-19. The full manuscript can be accessed by clicking the image above or by clicking here. The Italian authors base their hypothesis for preventing and treating covid-19 patients to prevent the "virus activated cytokine storm syndrome", which is thought to lead to the death of covid-19 patients (1). In a nutshell, the aforementioned cytokine storm, is simply the inflammatory response that occurs as a result of the immune system's attack on the virus and can be measured by laboratory values of IL-6 and alpha-TNF.

Not everybody who has the virus seems to have an exaggerated immune response capable of inducing the cytokine storm, and those that do, seem to have more severe symptoms and risk of death from the virus. Normally, in the case of viruses, the release of cytokines is brief and effective in prompting the immune system to overcome an invading virus, but some research has shown that the prolonged elevation of IL-6 contributes to survival of the virus and worsening of infection. Another important cytokine, alpha TNF, is released during viral infections, and are an important type of white blood cell, involved in fighting infections in the lungs, especially influenza, but can also promote damage and scarring of lung tissue.

According to the researchers, previously published research showed high serum levels of IL-6 and alpha-TNF in covid-19 patients were negatively correlated to T cells. T cells are a type of white blood cells called lymphocytes, and are responsible for an arm of immunity called the adaptive immune system. When a pathogen such as a virus or bacteria passes through the blood, it first encounters a type of white blood cell called a macrophage. Macrophages are like the Pac Men of the immune system. They roam the blood and engulf pathogens, breaking them down into pathogen fragments, which should then cause activation of T cells. T cells' job is to then attack the virus and eliminate it from the body. So in summary, when IL-6 and alpha-TNF are elevated, T cells are low, inhibiting the body's ability to fight the virus and when IL-6 and alpha-TNF are lowered, T cell levels are restored and the virus is eliminated.

The researchers also detail the role of adiponectin, which is a type of cytokine produced by fat cells, which seems to modulate, rather than enhance the immune response by blocking the production of pro-inflammatory cytokines such as IL-6 and alpha-TNF. Here's where this all starts to come together. When adiponectin levels bounce back up, which happens in mild covid-19 infection, levels of IL-6 and alha-TNF come down, and the cytokine storm is dissipated. You may be wondering how nutrition plays a part in all of this, so let's move on to what the researchers propose.

There is evidence that nutrition may be able to influence adiponectin levels! In animal research, diets high in polyunsaturated fats with supplemented omega 3 fatty acids, increased adiponectin levels and research in humans shows a healthy lifestyle and a Mediterranean diet was associated with higher adiponectin levels, especially in older people. Omega-3 fats are known to have anti-inflammatory properties, reduce reactive oxygen species and reduce IL-6, alpha-TNF, and other inflammatory cytokines. Foods high in omega 3 fats include: salmon, anchovies, sardines, herring, fresh water trout, grass fed beef and free range or omega-3 eggs. Fish oil supplements are also a good source of omega 3 fats, but should be used only if recommended by your healthcare professional or dietitian who is familiar with your specific medical history. Some plant foods, such as flaxseed, chia seeds, and walnuts also have high amounts of omega 3 fats, however, may not be easily utilized by the body, and are still considered staples of healthy eating.

Additionally, the researchers cite previous research on the protective role of antioxidants such as vitamin C, polyphenols, flavonoids in lung infections, which may be important in quelling the inflammatory response as well. Below is Table 1 from the referenced research and contains examples of ways to obtain flavonoids, polyphenols and vitamin C through natural sources.

The researchers call for clinical research using therapies such as omega 3 fats, vitamin C, flavonoids, and polyphenols such as EGCG, to support their hypothesis that these substances can help prevent infection of covid-19 and improve outcomes of those who contract the virus.

My Thoughts

There is very little information on non-pharmaceutical approaches to preventing and treating covid-19 and it is very unfortunate, both because the virus is very new and because non-pharmaceutical research and theories are labeled as misinformation and condemned as false treatments by the FDA. China is conducting clinical trials using high dose intravenous vitamin C for the treatment of covid-19, but in the US, we may never learn about the results of these trials for a variety of reasons I won't go into here. Despite a lack of research on non-pharmaceutical approaches for preventing and treating covid-19, I am reassured by what we already know about the body, the immune system, and how to optimize health. We can all benefit from building a nest in which we focus on things within our control. A simple search on Pubmed yields results of over 17,000 published research on nutrition and the immune system. We can tap onto the abundance of what we already know about the human body and human nutrition. We can continue to eat nourishing, high quality foods, avoid inflammatory processed fats and sugar, and build strength and resiliency through breath work, movement and healthy bedtime habits. Doctors have been telling people for decades to eat healthy, move more and reduce stress, so why stop now? We don't need clinical trials to tell us to nourish our body, mind and spirit as best as we can.

Reference:

1. Messina, G.; Polito, R.; Monda, V.; Cipolloni, L.; Di Nunno, N.; Di Mizio, G.; Murabito, P.; Carotenuto, M.; Messina, A.; Pisanelli, D.; Valenzano, A.; Cibelli, G.; Scarinci, A.; Monda, M.; Sessa, F. Functional Role of Dietary Intervention to Improve the Outcome of COVID-19: A Hypothesis of Work.Int. J. Mol. Sci.2020,21, 3104.