COVID-19: Your role in nutrition and lifestyle changes; boosting ‘innate immunity’

Two questions that are top-of-mind in our scientific community;

  1. How do we protect ourselves and reduce personal risk of contracting coronavirus?
  2. How do we fortify our immune system and mount an effective response in the event that we contract the disease? 

At the center of the second question is the role of nutrition and lifestyle changes in boosting the innate immunity needed to fight the disease.

PROLOUGE:

Our world is no stranger to influenza pandemics.  E.g.:

+ Spanish flu pandemic of 1918 that claimed over 50 million lives

+ Asian Flu (1957-1958)

+ Hong Kong Flu in 1968

+ Swine Flu in 2009

Now – the ongoing SARS CoV-2 (Coronavirus- COVID-19) pandemic continues to pack its punch with unprecedented disruption of lives, global economic down turn and direct threat to personal existence.

However, since the beginning of recorded history – humans have developed ‘herd’ immunity through nutrition and lifestyle modification.

The role of nutrition in maintaining health and modifying disease outcomes has been known for ages.  While the full impact of nutritional status and nutrition support on COVID-19 remains to be fully elucidated, emerging evidence shows that certain markers of malnutrition (low serum albumin and reduced blood lymphocytes) negatively impact outcomes in patients with COVID-191,2.  The potentially overwhelming inflammatory response that occurs with severe COVID-19 infection may rapidly deplete nutrient reserves and result in malnutrition with devastating consequences that include increased mortality. A proactive approach to strengthen the body immune defense through ingestion of immune-supportive nutrients in healthy individuals as well as during the acute and recovery phases of COVID-19 constitutes a simple but effective strategy to positively influence outcome from the disease and potentially save lives.

REGARDING COVID-19:

Does Whey Protein offer immune-protective + antiviral/antimicrobial benefits?

Milk is made of 80% casein and 20% whey protein. Whey protein is produced either by extracting casein from milk or produced as a by-product of cheese making from milk. Whey is considered a high biological value protein with excellent bioavailability and amino acid profile. Whey proteins contain high concentration of Branched Chain Amino Acid (BCAA) leucine responsible for stimulating protein synthesis and development of muscle mass, hence its use in sports nutrition. Whey protein also has a host of other health benefits that include its antiviral4, antimicrobial5,6, immune modulating7 and antioxidant8,9 properties owing chiefly to whey protein lactoferrin fraction which plays a significant role in the innate immune system and considered to be an important host defense molecule.  Whey-rich supplements therefore have the potential to offer these immune-protective antiviral/antimicrobial benefits stemming from whey lactoferrin fraction.

Could Anti-oxidants increase our immune response regarding COVID-19?

Antioxidants are endogenously produced in the body or sourced from outside of the body (exogenous source) through ingestion of plant-based food items that are rich in antioxidants.  When ingested, antioxidants help the body get rid of potentially harmful waste products (“free-radicals”) that are produced either as by-products of food processing within the body, effect of environmental stress (for example pollution, radiation, cigarette smoke UV light) or inflammatory processes resulting from a wide range of diseases.  These free radicals directly damage cells, inflicting “oxidative stress”, which has been linked to aging, cancer, heart disease, respiratory diseases and inflammatory conditions like arthritis and immune disorders.  Antioxidants act as “scavengers” of these free radicals in the body and prevent oxidative damage to cells, tissues and organs.

Antioxidants also directly enhance lymphocyte activity and lymphocyte proliferation in response to an immune trigger; antioxidants potentiate “natural killer cell” activity in response to viral infection and increase production of chemicals called interleukins that ordinarily help contain the effects of invading agents.  Food rich in antioxidants are extremely beneficial in strengthening our immune health and prevent development of chronic medical conditions like heart and lung disease, cancer, diabetes and a host of inflammatory conditions.

Common examples of exogenous anti-oxidants and their sources include:

NutrientsBiological ActivitiesCommon Food Sources
Vitamin CPotent antioxidantGuava, kiwi, bell peppers, strawberries, oranges, papaya, broccoli, tomato, kale, grapefruit, persimmon, spinach, pineapple  
Vitamin AAntioxidant property; protects respiratory mucosal barrier functionBeef liver, cod liver oil, sweet potatoes, carrots, black-eyed peas, spinach, broccoli  
Vitamin EAntioxidant activitySunflower seeds, almonds, avocados, spinach, butternut squash, kiwi, broccoli, olive oil, trout, shrimp
Vitamin D***Lowers viral replication rates; reduces production of injurious inflammatory chemicals and increases production of protective inflammatory chemicals.Cod liver oil, mushrooms, salmon, herring and sardines, canned tuna, egg yolks, beef liver and cheese
Carotenoids and LuteinAntioxidant activity; converted to vitamin A in the bodyColorful red and orange plants fruits and vegetables like squash, apricots, oranges, grapefruit and carrots, kale, tomatoes, mangos, watermelon, papaya
SeleniumCofactor in endogenous synthesis of antioxidant glutathione in the liverBrazil nut, tuna, shellfish, eggs, sunflower seeds, shiitake mushrooms
FlavonoidsAnti-oxidant activity, Metal ion chelation and Modulation of cell-signaling pathwaysBerries; red/purple grapes; red wine; black tea; cocoa-based products; broccoli; citrus fruits; kale; soy foods

*** Recent studies show that vitamin D supplementation could reduce the risk of influenza and COVID-19 infection and deaths.10

The European Society for Clinical Nutrition and Metabolism (ESPEN) and COVID-19:

As with most areas of study regarding COVID-19, our current understanding of the role of specific nutrients and supplements is fluid and continues to evolve.  The European Society for Clinical Nutrition and Metabolism (ESPEN) Expert Statements and Practical Guidance for Nutritional Management of Individuals with SARS-CoV-2 Infection3 suggests:

  1.  “provision of daily allowances for vitamins and trace elements be ensured to malnourished patients at risk for or with COVID-19.” 
  2. “use oral nutritional supplements (ONS) whenever possible to meet patient’s needs, when dietary counseling and food fortification are not sufficient to increase dietary intake and reach nutritional goals.  ONS shall provide at least 400 kcal/day including 30 g or more of protein/day and shall be continued for at least one month.”

Summary of Historical Evidence and possible COVID-19 regimens:

  • Our understanding of the epidemiology, pathophysiology and treatment of COVID-19 continue to evolve.
  • No specific nutrition management plan or specific nutrient(s) has been clinically proven to influence the outcome of COVID-19.  Information provided in this article is based on general principles and practice in nutritional management of patients and should not be construed as authoritative or treatment recommendation for COVID-19. 
  • Based on general principles of nutritional care during illness, it appears prudent at this time to ensure adequate nutrient intake with a strong preference for food that are rich in immune-supportive antioxidants and vitamins and proteins at recommended daily allowances.
  • Obtaining immune-supporting nutrients from varied food sources is preferred to intake of vitamin and mineral supplements
  • Patients who are unable to meet recommended daily allowances should receive high ONS, preferably whey-rich ONS, to exploit the immune-supporting properties of lactoferrin whey.

Article written by:
Tunde Onamusi, MD, MPH
CEO/Founder Amerix Medical Nutrition
Ohio, USA

Visit: www.AmerixNutrition.com to learn more about our Nutrition product portfolio.

Sources

  1. Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395:1054–1062.
  2. Laviano et al. Nutrition support in the time of SARS-CoV-2 (COVID-19) / Nutrition 00 (2020) 110834
  3. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection: https://www.sciencedirect.com/science/article/pii/S0261561420301400
  4. Berlutti F, et al. Antiviral properties of lactoferrin–a natural immunity molecule. Molecules. 2011 Aug 16; 16(8):6992-7018.
  5. Embleton ND, et al. Lactoferrin: Antimicrobial activity and therapeutic potential. Semin Fetal Neonatal Med. 2013 Jun; 18(3):143-149.
  6. Leboffe L et al. Antifungal and antiparasitic activities of lactoferrin. Anti-Infect. Agents Med. Chem. 2009;8:114–127. doi: 10.2174/187152109787846105.
  7. Siqueiros-Cendón T, et al.  Immunomodulatory effects of lactoferrin. Acta Pharmacol Sin. 2014 May; 35(5):557-66.
  8. Kanwar JR, et al. Multifunctional iron bound lactoferrin and nanomedicinal approaches to enhance its bioactive functions. Molecules. 2015 May 26; 20(6):9703-31.
  9. Brock JH, et al Lactoferrin–50 years on. Biochem Cell Biol. 2012 Jun; 90(3):245-51.
  10. Grant WB, et al.  Evidence that Vitamin D supplementation could reduce the risk of influenza and COVID-19 infection and deaths. Nutrients 2020 Apr 2;12(4). pii: E988. doi: 10.3390/nu12040988.