COVID-19 and Nutrition Conundrum

Coronavirus disease (COVID-19) which is an infectious disease caused by a newly discovered coronavirus namely severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most people that are infected with the COVID-19 virus experience mild to moderate respiratory illness and recover without requiring special treatment

COVID-19 and Nutrition conundrum- what is for commoners in the arsenal of world leading Nutrition Societies?

Author:

Dr.Atta ur Rehman Khan, Pakistan

As tsunami of COVID-19 cases has taken over the entire world since the dawn of 2020, we are without clue of what will work against this novel virus which knows no boundaries, undiscriminating, un-racial, un-ethnic unlike us, and spreading without passport crossing all castles of disease control and prevention build by the gurus of so called modern health care systems? There is no weapon in our arsenal to surefire. Coronavirus disease (COVID-19) which is an infectious disease caused by a newly discovered coronavirus namely severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most people that are infected with the COVID-19 virus experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer have a higher risk to develop serious illness. At the moment, the vaccines or treatments for COVID-19 is nonexistent. Although, many ongoing clinical trials are under way in search of effective treatments.

The clickbait headlines have taken us by storm. The flood of diet QUICKFIXES is prevailing like never before. Many have stated and shared that “The importance of plenty of liquids and hot drinks have been proven to be beneficial in relieving the symptoms as well as the enhancing the antioxidant effects” and many comment “High Carbs foods are notoriously bad and suppress your immune system” and a lot yell at fats by cursing like “High fats also lead to putting on extra fats which in turns threatens the integrity of our body defense lines” and few suggest “Keep your diet low in foods of animal origin” as well as to “Be generous on fruits and veggies as these foods are natural hub of antiviral and anti-bacterial substances” besides “Plenty of fluids are required by the body to keep the fighter cells hydrated and regulate the body temperature” and “High protein foods are mandatory to supply your defenses with the fighting ammunition” And others are debunking junk foods like “Strictly clamp down on junk foods such as chocolates, sweats, sodas, fast foods” etc.

As of now, it is self-evident that we are living in the world of toxic and unreliable information, so thought to just share with you the viewpoint of International Nutrition Societies directly extracted from their position statements.

1.Academy of Nutrition and Dietetic

The following nutrients play a role in the immune system and can be found in a variety of foods:

· Beta Carotene is found in plant foods, such as sweet potatoes, spinach, carrots, mango, broccoli and tomatoes.

· Vitamin C-rich foods include citrus fruits, berries, melons, tomatoes, bell peppers and broccoli.

· Vitamin D is found in fatty fish and eggs. Milk and 100% juices that are fortified with vitamin D also are sources of this important nutrient.

· Zinc tends to be better absorbed from animal sources such as beef and seafood, but also is in vegetarian sources such as wheat germ, beans, nuts and tofu.

· Probiotics are “good” bacteria that promote health. They can be found in cultured dairy products such as yogurt and in fermented foods such as kimchi.

· Protein comes from both animal and plant-based sources, such as milk, yogurt, eggs, beef, chicken, seafood, nuts, seeds, beans and lentils.

Focus on BalanceTo help keep your immune system healthy all year long, focus on a balanced eating plan, adequate sleep and stress management.

Aim for five to seven servings of vegetables and fruits daily to get vitamins, minerals and antioxidants that may support immune health.

Good hygiene and hand-washing help prevent the spread of germs. Remember to wash produce before eating or using in recipes. Clean glasses, forks, spoons and other utensils to reduce the spread and growth of bacteria.

Find healthy and appropriate ways to cope with stress, such as meditation, listening to music or writing. Physical activity also is a great way to help manage stress and may help reduce the risk of some chronic diseases that could weaken your immune system further.

Lack of sleep contributes to a variety of health concerns, such as a weakened immune system. Seven to nine hours is recommended each day for adults, and children need eight to 14 hours, depending on their age.

What About Herbals?

Many herbal remedies are marketed to help fight colds or shorten their duration but check with your health care provider before taking any supplement.

2.British Dietetic Association

On 24 Mar 2020 The British Dietetic Association (BDA), representing dietitians across the UK, call on the public and media to stop the spread of nutrition pseudoscience in the face of the coronavirus pandemic. With many people sharing un-sourced ‘advice’ about miracle supplements and foods that prevent infection, dietitians at the BDA have created a comprehensive hub of evidence-based and fact-checked nutrition information relating to the coronavirus pandemic. They are updating it all the time and are keen to get it into the hands of as many people as possible.

Can I boost my immune system through my diet?

Simply put, you cannot “boost” your immune system through diet, and no specific food or supplement will prevent you catching COVID-19/Coronavirus. Good hygiene practice remains the best means of avoiding infection.

There are many nutrients that are involved with the normal functioning of the immune system, so we would encourage maintaining a health balanced diet in order to support immune function (include copper, folate, iron, selenium, zinc and vitamins A, B6, B12, C and D). We don’t recommend any one food over another, but instead encourage eating a variety of foods to maintain a health balanced diet. Although eating a well-balanced diet can help ensure the normal functioning of the immune system, not individual nutrient, food or supplement is going to “boost” it beyond normal levels. Good hygiene practice remains the best means of avoiding infection. However, if you are self-isolating, especially if you have symptoms, it is important to maintain good nutrition and hydration. Make sure you are eating and drinking regularly, even if you have low appetite.

For people with specific nutrition needs, it is important to continue to follow the dietary recommendations made by your dietitian or other healthcare professional. This may involve asking friends or family members to get you specific foods so you can continue to follow an appropriate diet.

“People sharing unevidenced nutrition solutions to COVID-19 may increase the risk that someone doesn’t take proper hygiene and social distancing precautions. It’s vital that we stop spreading this misinformation.” Says Andy Burman, BDA CEO.

“Our dietitians, like all health care staff, are working tirelessly at the moment to support the growing number of COVID-19 hospital admissions. Proper nutrition can support improved outcomes for patients in ICU, where we know those COVID-19 patients with the most acute need will be.

“As our members are preparing with their colleagues to support the coronavirus effort in any way they can, including re-deployment into the areas where support is most needed, they are also working hard out of hours to make sure the public have access to good nutritional advice and guidance.

“In these extraordinary times, when it may be more difficult for people with less-serious conditions to access direct dietetic help, we want to reach as many people as we can. Our public advice is here to support anyone who does not need to go into hospital or work directly with a clinician.”

Why is malnutrition important to consider for COVID-19?

Many people who fall into the at-risk group and have been advised to follow stay at home, are also those considered to be at greater risk of malnutrition.

Malnutrition is a serious condition which can increase a person’s risk of infection as well as slowing down their recovery. Those with an infection are also at higher risk of developing malnutrition which slows their recovery.

Malnutrition is also more common for older people and those who are already socially isolated. Social distancing and social isolation could impact a person’s access to the wide variety of foods needed to keep healthy and may make them want to eat less.

Malnutrition can also increase the risk of frailty, which is also more common in older age. Frailty can lead to weaker muscles and make people more vulnerable to infections, falls and needing extra care.

Unintentional weight loss due to disease or infection is not good, whatever someone’s original body weight was. Healthy eating in older age may look different to the general healthy eating guidelines. This is because older people are more at risk of malnutrition. Some older people may need reassuring that their diet should be different.

If you are self-isolating and especially if you have symptoms, it is important to maintain good nutrition and hydration. Make sure you are eating and drinking regularly, even if you have low appetite.

If you have specific nutrition needs, it is important that you continue to follow the dietary recommendations made by your dietitian or other healthcare professional. This may involve asking friends or family members to get you specific foods so you can continue to follow an appropriate diet.

Should I take Vitamin D supplement?

Vitamin D works with calcium and phosphorus for healthy bones, muscles and teeth. It is also important in protecting muscle strength and preventing rickets, osteomalacia and falls.

In normal circumstances, sunshine, not food, is where most of your vitamin D comes from. So even a healthy, well-balanced diet, that provides all the other vitamins and nutrients you need, is unlikely to provide enough vitamin D if you aren’t able to get enough sun. During autumn and winter months when we spend more time indoors and the sun is weaker, adults and children over the age of one are advised to take a daily supplement containing 10 micrograms of Vitamin D.

Now we are in spring, if you can, you should seek to spend some time outdoors in the sunshine (e.g. your garden or balcony). However, if you are having to self isolate or if you are unable to go outside, you should consider taking a daily supplement containing 10 micrograms to ensure a healthy vitamin D status (for adults and children over the age of one).

All babies under one year should be given a daily supplement of 8.5-10 micrograms unless they have more than 500mls of fortified formula milk.

You can also eat plenty of vitamin D rich foods, including:

  • Oily fish such as salmon, sardines, pilchards, trout, herring, kippers and eel contain reasonable amounts of vitamin D.
  • Cod liver oil contains a lot of vitamin D, but don’t take this if you are pregnant.
  • Egg yolk, meat, offal and milk contain small amounts, but this varies during the seasons.
  • Margarine, some breakfast cereals, infant formula and some yoghurts have added vitamin

It is very unlikely that you can catch coronavirus from food. COVID-19 is a respiratory illness. It is not known to be transmitted by exposure to food or food packaging.

Please continue to follow general food safety advice; washing hands thoroughly, cleaning surfaces and separating raw meat/fish from other foods when preparing food.

3.Dietitian of Canada

Can I boost my immune system through my diet?

Simply put, you cannot “boost” your immune system through diet and no specific food, supplement or natural health product will prevent you from catching COVID-19. Proper hygiene can help reduce the risk of infection or spreading infection to others. To date, the Government of Canada has not approved any product to prevent, treatorcureCOVID-19. There are many nutrients that are involved with the normal functioning of the immune system and therefore we encourage eating a variety of healthy foods each day in order to support immune function.

What nutrition advice would you give for someone who may have contracted COVID-19 and is self-isolating as a result?


At this time, there is no vaccine for COVID-19 or any natural health products that are authorized to treat or protect against COVID-19.

If you are self-isolating and especially if you have symptoms, it is important to maintain good nutrition and hydration. Make sure you are eating and drinking regularly, even if you have a low appetite. If you have specific nutrition needs, it is important that you continue to follow the dietary recommendations made by your dietitian, doctor or nurse practitioner. This may involve asking a family member, friend or neighbor to get you specific foods so you can continue to meet your specific needs. Contact your dietitian, doctor or nurse practitioner by phone or email if you have serious concerns.

Everyone is encouraged to be aware of people in their community that may have difficulty accessing food, and look for ways to support each other.


Should I continue to breastfeed my baby if I have COVID-19 or suspect I have COVID-19?

The Society of Obstetricians and Gynaecologists of Canada (SOGC) have released a statement on COVID-19 in pregnancy. Within this statement, they make the following postpartum and newborn care recommendations:

  • Women who choose to breastfeed should be allowed to do so after appropriate handwashing and while wearing a mask. It is possible that the mother can transmit antibodies to the infant through breastmilk; however, there is limited evidence of this transmission and the potential benefits are unclear.
  • Management in the post-partum period should be guided by a patient-centred discussion about the available evidence and its limitations.
  • We do not recommend universal isolation of the infant from either confirmed or suspected infection in the mother. However, depending on a family’s values and availability of resources they may choose to separate infant from mother until isolation precautions for the mother can be formally discontinued.
  • Women should practice good handwashing before and use of a mask while engaging in infant care.

4.Dietition Association of Australia

COVID-19 tips and resources

Planning your pantry for COVID-19

With the COVID-19 pandemic sweeping across the globe, eating nutritious foods and having an adequate access to food is now top of mind for many.

To help ease some of the confusion, we’ve collated some steps to take to help you feel prepared regarding your food supply, in the event you need to self-quarantine for 14 days.

Preparing your household for quarantine

Recently, we’ve seen people flocking to the stores to stock up on pantry staples. Panic-buying food places greater strain on the poorest and most vulnerable members of our community and increases the risk of food insecurity and poor health. Being sensible at the supermarket is key to looking after the health of our whole community.

In the event of needing to self-quarantine, it’s important to have a plan. This is especially the case if you or a family member falls ill and you can’t leave the house. Making a plan that works for your household (rather than just stockpiling lots of food) means you are well prepared. It’s also more considerate of others in your community.

Step 1: Look at what you already have

The first step is to look at what you already have. Check out what you have in your pantry and freezer and look at their use-by date. You may even be able to free up space at the back of the freezer by throwing out those ‘forgotten foods’ that may no-longer be safe to consume. The Commonwealth Scientific and Industrial Research Organisation (CSIRO) provides some handy tips regarding safe handling and storage of food at home.

Step 2: Make a list

Next, make a list of longer lasting and shelf stable foods from the major food groups as outlined below to guide you at the supermarket. Purchase items your household will eat and enjoy, to prevent future food wastage. For canned food, check you have a working can opener (or choose cans with ‘ring pulls’).

Step 3: Go shopping

Food items to consider:

  • Fruit: Fresh fruit (choose those that last longer such as apples, bananas and citrus fruits), frozen fruits, dried fruit (eat in small amounts) and canned varieties.
  • Vegetables: Fresh produce (choose those that last longer, such as potatoes, onions, carrots, pumpkin, and cabbage), frozen vegetables and canned vegetables (e.g. tinned tomatoes, corn, beetroot etc).
  • Cans of soup
  • Protein sources:

o Canned fish (e.g. salmon, tuna or sardines)

o Legumes (canned or dried)

o Nuts and seeds (including nut butters)

o Long life milk (UHT or powdered milk)

  • Grains: Consider a range of grains such as rice, pasta, quinoa, cous cous, rolled oats and cereals. Freezing a loaf of bread or wraps can also extend its freshness and shelf life.
  • Long life sauces/herbs and spices: Relying on shelf-stable foods, can increase the sodium in our diet, as salt is used to help preserve foods. Having a range of herbs and spices on hand can help boost the flavour of foods without needing to extra salt.
  • Foods for enjoyment: In times of isolation and uncertainty, having foods that are a source of comfort, or a reminder of daily routine, can be beneficial for your mental health. Some examples include coffee or chocolate. While you won’t need much, it’s important they’re not forgotten.

Step 4: Get cooking

At the moment, it’s best to focus on easy recipes with simple ingredients. It is also worth cooking a little extra so you have a few meals prepared and frozen in the freezer. This helps to provide meal variety and — if you were to fall ill — means you have a nutritious option ready to go.

5.Harvard Medical School

Helpful ways to strengthen your immune system and fight off disease

How can you improve your immune system? On the whole, your immune system does a remarkable job of defending you against disease-causing microorganisms. But sometimes it fails: A germ invades successfully and makes you sick. Is it possible to intervene in this process and boost your immune system? What if you improve your diet? Take certain vitamins or herbal preparations? Make other lifestyle changes in the hope of producing a near-perfect immune response?

What can you do to boost your immune system?

The idea of boosting your immunity is enticing, but the ability to do so has proved elusive for several reasons. The immune system is precisely that — a system, not a single entity. To function well, it requires balance and harmony. There is still much that researchers don’t know about the intricacies and interconnectedness of the immune response. For now, there are no scientifically proven direct links between lifestyle and enhanced immune function.

But that doesn’t mean the effects of lifestyle on the immune system aren’t intriguing and shouldn’t be studied. Researchers are exploring the effects of diet, exercise, age, psychological stress, and other factors on the immune response, both in animals and in humans. In the meantime, general healthy-living strategies are a good way to start giving your immune system the upper hand.

Healthy ways to strengthen your immune system

Your first line of defense is to choose a healthy lifestyle. Following general good-health guidelines is the single best step you can take toward naturally keeping your immune system strong and healthy. Every part of your body, including your immune system, functions better when protected from environmental assaults and bolstered by healthy-living strategies such as these:

· Don't smoke.

· Eat a diet high in fruits and vegetables.

· Exercise regularly.

· Maintain a healthy weight.

· Get adequate sleep.

· Take steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly.

· Try to minimize stress.

Increase immunity the healthy way

Many products on store shelves claim to boost or support immunity. But the concept of boosting immunity actually makes little sense scientifically. In fact, boosting the number of cells in your body — immune cells or others — is not necessarily a good thing. For example, athletes who engage in “blood doping” — pumping blood into their systems to boost their number of blood cells and enhance their performance — run the risk of strokes.

Attempting to boost the cells of your immune system is especially complicated because there are so many different kinds of cells in the immune system that respond to so many different microbes in so many ways. Which cells should you boost, and to what number? So far, scientists do not know the answer. What is known is that the body is continually generating immune cells. Certainly it produces many more lymphocytes than it can possibly use. The extra cells remove themselves through a natural process of cell death called apoptosis — some before they see any action, some after the battle is won. No one knows how many cells or what the best mix of cells the immune system needs to function at its optimum level.

Immune system and age

As we age, our immune response capability becomes reduced, which in turn contributes to more infections and more cancer. As life expectancy in developed countries has increased, so too has the incidence of age-related conditions.

While some people age healthily, the conclusion of many studies is that, compared with younger people, the elderly are more likely to contract infectious diseases and, even more importantly, more likely to die from them. Respiratory infections, influenza, and particularly pneumonia are a leading cause of death in people over 65 worldwide. No one knows for sure why this happens, but some scientists observe that this increased risk correlates with a decrease in T cells, possibly from the thymus atrophying with age and producing fewer T cells to fight off infection. Whether this decrease in thymus function explains the drop in T cells or whether other changes play a role is not fully understood. Others are interested in whether the bone marrow becomes less efficient at producing the stem cells that give rise to the cells of the immune system.

A reduction in immune response to infections has been demonstrated by older people’s response to vaccines. For example, studies of influenza vaccines have shown that for people over age 65, the vaccine is much less effective compared to healthy children (over age 2). But despite the reduction in efficacy, vaccinations for influenza and S. pneumoniae have significantly lowered the rates of sickness and death in older people when compared with no vaccination.

There appears to be a connection between nutrition and immunity in the elderly. A form of malnutrition that is surprisingly common even in affluent countries is known as “micronutrient malnutrition.” Micronutrient malnutrition, in which a person is deficient in some essential vitamins and trace minerals that are obtained from or supplemented by diet, can be common in the elderly. Older people tend to eat less and often have less variety in their diets. One important question is whether dietary supplements may help older people maintain a healthier immune system. Older people should discuss this question with a physician who is well versed in geriatric nutrition, because while some dietary supplementation may be beneficial for older people, even small changes can have serious repercussions in this age group.

Diet and your immune system

Like any fighting force, the immune system army marches on its stomach. Healthy immune system warriors need good, regular nourishment. Scientists have long recognized that people who live in poverty and are malnourished are more vulnerable to infectious diseases. Whether the increased rate of disease is caused by malnutrition’s effect on the immune system, however, is not certain. There are still relatively few studies of the effects of nutrition on the immune system of humans, and even fewer studies that tie the effects of nutrition directly to the development (versus the treatment) of diseases.

There is some evidence that various micronutrient deficiencies — for example, deficiencies of zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E — alter immune responses in animals, as measured in the test tube. However, the impact of these immune system changes on the health of animals is less clear, and the effect of similar deficiencies on the human immune response has yet to be assessed.

So what can you do? If you suspect your diet is not providing you with all your micronutrient needs — maybe, for instance, you don’t like vegetables — taking a daily multivitamin and mineral supplement may bring other health benefits, beyond any possibly beneficial effects on the immune system. Taking megadoses of a single vitamin does not. More is not necessarily better.

Improve immunity with herbs and supplements?

Walk into a store, and you will find bottles of pills and herbal preparations that claim to “support immunity” or otherwise boost the health of your immune system. Although some preparations have been found to alter some components of immune function, thus far there is no evidence that they actually bolster immunity to the point where you are better protected against infection and disease. Demonstrating whether an herb — or any substance, for that matter — can enhance immunity is, as yet, a highly complicated matter. Scientists don’t know, for example, whether an herb that seems to raise the levels of antibodies in the blood is actually doing anything beneficial for overall immunity.

Stress and immune function

Modern medicine has come to appreciate the closely linked relationship of mind and body. A wide variety of maladies, including stomach upset, hives, and even heart disease, are linked to the effects of emotional stress. Despite the challenges, scientists are actively studying the relationship between stress and immune function.

For one thing, stress is difficult to define. What may appear to be a stressful situation for one person is not for another. When people are exposed to situations they regard as stressful, it is difficult for them to measure how much stress they feel, and difficult for the scientist to know if a person’s subjective impression of the amount of stress is accurate. The scientist can only measure things that may reflect stress, such as the number of times the heart beats each minute, but such measures also may reflect other factors.

Most scientists studying the relationship of stress and immune function, however, do not study a sudden, short-lived stressor; rather, they try to study more constant and frequent stressors known as chronic stress, such as that caused by relationships with family, friends, and co-workers, or sustained challenges to perform well at one’s work. Some scientists are investigating whether ongoing stress takes a toll on the immune system.

But it is hard to perform what scientists call “controlled experiments” in human beings. In a controlled experiment, the scientist can change one and only one factor, such as the amount of a particular chemical, and then measure the effect of that change on some other measurable phenomenon, such as the amount of antibodies produced by a particular type of immune system cell when it is exposed to the chemical. In a living animal, and especially in a human being, that kind of control is just not possible, since there are so many other things happening to the animal or person at the time that measurements are being taken.

Despite these inevitable difficulties in measuring the relationship of stress to immunity, scientists are making progress.

Does being cold give you a weak immune system?

Almost every mother has said it: “Wear a jacket or you’ll catch a cold!” Is she right? So far, researchers who are studying this question think that normal exposure to moderate cold doesn’t increase your susceptibility to infection. Most health experts agree that the reason winter is “cold and flu season” is not that people are cold, but that they spend more time indoors, in closer contact with other people who can pass on their germs.

But researchers remain interested in this question in different populations. Some experiments with mice suggest that cold exposure might reduce the ability to cope with infection. But what about humans? Scientists have dunked people in cold water and made others sit nude in subfreezing temperatures. They’ve studied people who lived in Antarctica and those on expeditions in the Canadian Rockies. The results have been mixed. For example, researchers documented an increase in upper respiratory infections in competitive cross-country skiers who exercise vigorously in the cold, but whether these infections are due to the cold or other factors — such as the intense exercise or the dryness of the air — is not known.

A group of Canadian researchers that has reviewed hundreds of medical studies on the subject and conducted some of its own research concludes that there’s no need to worry about moderate cold exposure — it has no detrimental effect on the human immune system. Should you bundle up when it’s cold outside? The answer is “yes” if you’re uncomfortable, or if you’re going to be outdoors for an extended period where such problems as frostbite and hypothermia are a risk. But don’t worry about immunity.

Exercise: Good or bad for immunity?

Regular exercise is one of the pillars of healthy living. It improves cardiovascular health, lowers blood pressure, helps control body weight, and protects against a variety of diseases. But does it help to boost your immune system naturally and keep it healthy? Just like a healthy diet, exercise can contribute to general good health and therefore to a healthy immune system. It may contribute even more directly by promoting good circulation, which allows the cells and substances of the immune system to move through the body freely and do their job efficiently.

Although you may not be able to fully prevent an illness this season, a healthy immune system is one way to give your body extra protection. Focusing on nutrient-rich foods and healthy lifestyle behaviors can help you and your family stay a step ahead.

Further Resources:

Royal College of Paediatrics and Child Health and Royal College of Obstetricians and Gynaecologists website for up todate advice.

Unicef’s website for additional information on what parents should know about COVID-19.

Healthy eating at unlockfood.ca or Health Canada’s, Canada's Food Guide.
Public Health England have published guidance on COVID-19 for food businesses which should be followed to minimise the risk of infection from employees.

Selling unauthorized health products or making false or misleading claims to prevent, treat or cure COVID-19 is illegal in Canada. More information can be found here.
Information on eating a healthy diet in our Healthy Eating Food Fact Sheet

Information on staying hydrated in our Fluid Food Fact Sheet

For recipe ideas from APDs, see DAA’s Smart Eating Recipe collection. Many of these can be easily adapted for canned or frozen goods, and many can be made in batches and frozen for future use. Here are some good examples:

The emergence of COVID-19: Is it a proof of historical nutritional neglect

It is strange for many but I have to quote Shakespeare for a soft reminder to ourselves, what Nutrition entails “Artificialism” is hallmark of today. One classical example is of natural orange extracts which are used everywhere from cosmetics to paints but for our diet only remains the artificial orange flavors.

We are at dawn of third decade of 21st century and a tsunami of COVID-19 has taken over the entire world since last three months. This is the third time a Virus from same family SA RS- ( CoV-2) t hreat ened human life and led t o hist orical global locked down and we are still without clue of what will work against this deadly virus. There is no weapon in our arsenal to surefire. Coronavirus disease (COVID- 19) which is an infectious disease caused by a newly discovered coronavirus namely severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most people infected with the COVID-19 virus experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer have a higher risk to develop serious illness. At the moment, the vaccines or treatments for COVID-19 is nonexistent. Although, many ongoing clinical trials are under way in search of effective treatments.

Since there is a lot of hustle bustle if we do have an evidence or none from nutritionresearchtotreatCOVID-19.Letustakealook atthisconundrumanddo a reality check. This is well documented that poor nutrition is a key driver and risk factor for disease. Similarly, it is also well established scientific truth that nutritional deficiencies causeimpairmentofimmunefunctionandthusincreasevulnerability to all sorts of infections. As a result, infection also affects the normal body metabolism and status of several nutrients in human body. This brings us an adverse scenario and a vicious circle of under nutrition, compromised immune function and creates an ideal environment for microbial growth and infections. There is logical conclusion from these facts that optimal nutrition is the key for the prevention of many infections surely including viral such as COVID-19. We know little whether a good nutrition status can shield us against COVID-19 because covid-19 is new form of virus even different than the SARS and MERS for which no vaccine is yet available. In fact, in case of SARS and MERS we developed a natural immunity and as a result, the outbreak has almost lost its vigor and capacitytoinfect uswithsamepathogenicity.Here,one candefinitelyquestion that, was it nutrition which shielded us against CoV-2 and MERS. A reasonable

COVID-19: Have we neglected nutrition induced defenses? Graphic designer – Sahar Khan

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analysis from epidemiological statistics since 2002, it proved again that opt imal nutrition might have played a significant role to provide a barrier or did herd immunity came into play and halted race of further spread of these viral outbreaks. It may be through the mechanism of strengthening the immunogenicit y.

Thehumanimmunogenicitycomes intoplaybyactivationoftwogeneral systems: innate(natural)immunityand adaptive(specific, acquired) immunity.

1. Natural/Innateor Non-Specific defense system (Immunogenicity)includes

ext ernal physical barricades e.g. such as skin, mucous membrane and I nt ernal Defenses e.g. Phagocytes, antimicrobial proteins, soluble factors which provide an immediate first line of defense against invading microorganisms

2. Specific or acquires or adaptive defense system (immunogenicity) consists of Lymphocytes such as B-Cell (formation of antibodies), T-Cell and Natural killer (NK)-Cells. This is further divided into Humoral mediated immunity: response by lymphocytes like B-Cell (formation of antibodies) and Cell mediated immunity: response by lymphocytes like T-Cell and Natural killer (NK)-Cells. In T-Cells, there are types like Th (helper) Cells, T (Memory) cells, T (effector) cells. These T cells are more specific players towards the fight against COVID-19 that is being fought at natural/Nutritional or Pharmaceutical front

Nutritional factors can modify the characteristics of both host and infectious agent.An organism’s response to nutritionalinfluences is condition by such innate host feat ures as genet ic makeup, age and physiologic st at e, and by presence of complicating illness. A varietyof published evidence demonstratedconclusively that protein malnutrition when sufficiently severe and prolonged, had a profound effect on resistance to infections. The direct effect of malnutrition on host resistance is well documented. Dietary inadequacies have long been assumed to diminish resistance to infection by reducing the integrity of various tissues. Nutrient deficiencies frequently result in gross epithelial lesions. Examples are the met aplast ic hyperkerat osis due t o Vit amin A deficiency, t he dermat it is, cheilosis, and angular stomatitis from riboflavinosis and pyridoxine deficiency; the charact erist ic dermat osis and mucosal at rophy of pellagra; t he spongy gums and subcutaneoushemorrhages of scurvy;andtheatrophyofskin andgastrointestinal mucosa of severe protein deficiency. The mucosa of gastro-intestinal tract of vitamin-A-deficient cotton rats was more readily penetrated by poliovirus than the mucosa of control animals by weaver in 1946.

The outcome of a potential interaction between malnutrition and infection depends in part on innate host factors, such as age and genotype, and in part

COVID-19: Have we neglected nutrition induced defenses? Graphic designer – Sahar Khan

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on abnormal physiologic states, metabolic disorders and acquired immunity. Interaction also depends on the genetic constitution of infection agent. If the agent is uniformly highly virulent or the uniformly avirulent the effect of the diet may be minimal. In the same way the innate resistance of the host may be so slight or so great that diet is of secondary importance. When Schneider Model (1950) further explained by Dr.Scrimshah and fellows, It seems that diet should then influence the severity of infectious disease in nearly 50% of case. Schneider 1950 used three (3) genotypes (Selected resistant, Selected susceptibility, Unselected strainsof mice) and three(3)different culturesof salmonella (Virulent, uniformly avirulent and Mixed).Nutrient excess may have either an adverse on reproduction or pathogenicityof infectious agent.Both infectious and nutritional diseases are dynamic and changing in characteristics and frequency as the conditions causing them to change. In the ecologically balanced populations characteristically present in nature, the situation is an intermediate level of both virulence of agent and resistance of host, with the result that diet often determinestheoutcomes, dietaryfactorsthushavegreatersignificance innature and in public healt h t han some laborat ory experiment s suggest .

Recent studies involving Nutritionists, Virologists and Immunologists have reported unanimous evidence which strongly supports associations of low levels or intakes of micronutrients such as vitamins A, E, B6 and B12, Zn and Se adverse clinical outcomesduringviralinfectionsandproposed thatvitaminsB,vitaminC,omega- 3polyunsaturatedfattyacids,selenium, zincandironshouldbeconsidered inthe assessment of micronutrients in COVID-19 patients besides vitamins A and D (ESPEN). The Academy of Nutrition and Dietetic has stated that nutrients play a role in the immune system and can be found in a variety of foods. Focus on Balance is themain narrative.Tohelp keep your immune system healthyall year long, focus on a balanced eat ing plan, adequat e sleep and st ress management . Similarly, the British Dietetic Association on 24 Mar 2020 stated that there are many nutrients that are involved with the normal functioning of the immune system, so we would encourage maintaining a health balanced diet in order to support immune function (include copper, folate, iron, selenium, zinc and v itamins A, B6, B12, C and D). Malnutrition is a serious condition which can increase a person’s risk of infection as well as slowing down their recovery. Those with an infection are also at higher risk of developingmalnutritionwhichslowstheirrecovery.BDArecommends thatadultsand children over the age of one should take a daily supplement containing 10 micrograms of Vitamin D.

Obesity inhibits both virus-specific CD8+ T cell responses and antibody responses totheseasonal influenza vaccine and o

COVID-19: Have we neglected nutrition induced defenses? Graphic designer – Sahar Khan

besity-relatedconditionsseem toworsen

the effect of COVID-19; indeed, the Centers for Disease Control and Prevention

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(CDC) reported that people with heart disease and diabetes are at higher risk of

Evidenceis emerging that suggeststhat obesity-related conditions seem to worsen the effect of the virus; individuals with heart disease and diabetes are at higher risk of COVID-19 complications. The challenge for future virus pandemics is therefore not only to protect those affected by undernutrition, but also the growing number of people living with obesity. This is

particularly important for the WHO European Region as in many European countries obesity and overweight affects 30-70% of the population.

(WOF)

As a student of nutrition research, I intended to share the best possible ev idence. Honestly speaking, I hav e rev iewed the research w ork of immunology and physiology scientists since 1918 (w hich hav e been rev iewed elsew here), I found most experts agree on the protective role of Proteins, Vitamins and mineral in promoting the resistance against bacteria and v iruses. For example, the great nutritionist and Physician of his time, Nevin S.Scrimshah piled up hundreds of studies showing strong linked between nutrition and infections (Viral, Bacterial, Fungal, Protozoal and Helminths). Recently, Susanna Cunningham-Rundles after decades of her extensiv e research w ork conclusively stated that “When malnutrition is present, the overall development and expression of the immune response are significantly impaired”. Despit e t his huge effort s by scient ist s in t he field of immunology and Nut rit ion, much could not be t apped because the nut rition was at t he bot t om of priorit y list in t he healt hcare research. We could not materialize the initial results showing persistent association between Nutrition and infections into well designed clinical trials on human beings though there are tons of experimental animal studies. We failed at global scale to address this. Yes it is trulyworded in Lancer 2019 report “It iseveryone’s and no-one’s problem. Nutrition had no dedicated Millennium Development Goal and still has no Sustainable Development Goal (SDG). SDG 2, zero hunger, addresses only one of the many manifestations of poor nutrition. Despite several efforts, actions for improving nutrition have failed to gain global traction”

We conclude that moderate to severe nutritional deficiency increase the seriousness of infectious disease in man. Moreover, nutritional factors can modify the characteristics of both host and contagions. A variety of published evidence demonstrated conclusively that protein malnutrition when sufficiently severe and prolonged, had a profound effect on resist ance t o infect ions. Diet ary inadequacies diminish resistance toinfection by reducing theintegrityof various tissues.The immunity is precisely a system, not a single entity. To function well, it requires balance and harmony. There are many nutrients that are involved with the normal functioning of the immune system and therefore eating a variety of healthyfoods each day in order tosupport immune functionis a prudent strategy.

COVID-19: Have we neglected nutrition induced defenses? Graphic designer – Sahar Khan

COVI D-19 complicat ions.

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Preserving nutritional status and preventing or treating malnutrition also importantlyhasthepotentialtoreducecomplications and negativeoutcomesin patients at nutritional risk who might incur in COVID-19 in the future. Immaturation of T cells due malnut rition or t hymic at rophy due t o aging mechanism, one t hing is established that there is a strong relationship between nutrition and immunity in the elderly. For example, deficiencies of zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E alter immune responses in animals, and the effect of similar deficiencies on t he human immune response has yet t o be assessed. That is catch and should lead us to do clinical trials in human beings urgently. An ignored agenda of human nutrition clinical trials can be a window of opportunity that one find in the backdrop of COVID-19. SUSANNA CUNNINGHAM (2001) reported that new assay methods have enabled the design of experiments addressing different stages involved in immune-cell activation and the study of effects on signaling pathways, which may then lead to the characterization of causal relationships. Most investigations begin with a general assessment of how a nutrient or altered nutritional state affects the general parameters of the immune system, immune-cell subsets and function. Measurement of changes in frequency and number of circulat ing lymphocyt e subpopulat ions in t he course of observation or dietary intervention is now accepted as a useful and widely comparable procedure, but attention must be given to the issue of controls For human st udies, a complet e blood count and different ial are needed t o quant ify effects on absolute numbers of cells. Although there is frequently a limitation on blood tobe drawnfor nutritionalstudies,it is essential that thebaseline evaluation includes parallel studies providing a complete blood count, haematological analysis of haemoglobin, haematocrit, etc.

The lives of over a billion malnourished people are at stake. There is no quick fix and let s shift focus from panacea of all t ime medical remedies for communicable and non-communicable illnesses to most robust nutritional strategies. Time to RETHINK and take actionable drastic but sustainable measures including essentially the Syndemic oriented strategy to normalize life on mother planet earth. For this, we must ensure an equal distribution and sufficient supplies of food for all as a fundamental human right at urgent priority. Human Nutritional surveillance should get serious involvement of WHO for not only vulnerable population and groups but inclusive of every human being living on earth.This will eventually,make inroads for a healthfulnutritiontocome intoplay toturnaround thewheel and saveusfrom COVID-19and futurepandemics alike. Aboveshared body of nutritional evidence is undoubtedly convertible into a most reliable fighting tools and a surefire weapon to mitigate this cytokine storm before it re- emerges with more vigor. Stimulate the phagocytes as Dr.Bernard shaw said and

COVID-19: Have we neglected nutrition induced defenses? Graphic designer – Sahar Khan

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my addition to activate the T cells. Stay safe and shelter at home with a good nutritional shield.

The true remedy for all diseases is Nature’s remedy. Nature and Science are at one … Nature has

provided, in the white corpuscles as you call them – in the phagocytes as we call them – a natural

means of devouring and destroying all disease germs. There is at bottom only one genuinely

scientific treatment for all diseases, and that is to stimulate the phagocytes. Stimulate the

phagocytes… The phagocytes are stimulated; they devour the disease; and the patient recovers.

The Doctor’s Dilemma, Bernard Shaw

References:

WHO st at ement regarding clust er of pneumonia cases in Wuhan, China

https://www.who.int/china/news/detail/09-01-2020-who-statement-regarding- cluster-of-pneumonia-cases-in-wuhan-china (Jan 9, 2020), Accessed 11th Feb 2020

Chinese Center for Disease Control and Prevention:Tracking the epidemic http://weekly.chinacdc.cn/news/TrackingtheEpidemic.htm, Accessed 11th Feb 2020

Nevin S.Scrimshah et al :“ Interaction of Nutrition and infection”. WHO Monograph Series No:57

TheGlobal Syndemic of Obesity, Undernutrition,andClimateChange:The Lancet Commission report : January 27, 2019 2019

World Obesity Federation (https://www.worldobesity.org/news/statement- coronavirus-covid-19-obesity

Academy of Nutrition and dietetics (https://www.eatright.org/coronavirus) Harvard Medical School (https://www.bda.uk.com/resource/covid-19-corona-

virus-advice-for-the-general-public.html)

British dietetic Association (https://www.bda.uk.com/resource/covid-19-corona- virus-advice-for-the-general-public.html)

COVID-19: Have we neglected nutrition induced defenses? Graphic designer – Sahar Khan

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Centre for Disease control (CDC) https://www.cdc.gov/coronavirus/2019- nCoV/index.ht ml

European Society for clinical Nutrition and Metabolism (ESPEN)

1 thought on “COVID-19 and Nutrition Conundrum”

  1. Nadia K.K.M. Ahmed

    Hi Dr.
    I am a nutrition graduate with MSc. I am planning to do my PhD in any COVID 19 related topic. I would like to join any on-going research in nutrition.
    Thank you

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