While new cases of COVID-19 are on the decline in selected states, other areas are reporting localized outbreaks. Also troubling is the potential for resurgence in
the fall—coupled with the start of the flu season.

Centers for Disease Control and Prevention data shows that people of all ages with underlying health conditions, especially if unaddressed, may be at higher risk for serious illness from COVID-19. These underlying illnesses include chronic lung disease and moderate-to-severe asthma; serious heart conditions; the immune-compromised (example, people undergoing cancer treatment); severe obesity (body mass index/BMI of 40 or greater); type 2 diabetes; end-stage kidney disease; and liver disease.1

Additionally, high blood pressure (hypertension) appears to be a top underlying condition contributing to COVID-19 deaths in US communities.2

Besides donning PPE and keeping your distance, it’s sensical to ask what role nutrition might play in reducing the risk of serious disease from infection with the novel coronavirus (SARS-CoV-2), particularly for those over age 65 who are already living with, or on the threshold of, chronic illness.

FOOD AND INFLAMMATION

Inflammation isn’t inherently bad.

Acute inflammation is the body’s response to acute injury in which cytokines signal the immune system to repair damaged tissue, as well as defend against foreign bodies such as viruses. But when inflammation continues over time or happens where and when it isn’t needed, the process can become detrimental. When a burst of white blood cells rush toward a perceived threat that may not exist, they may eventually attack healthy organs and tissues.3 (There have been recent reports of a “cytokine storm” being linked to severe COVID-19.)

There is evidence that chronic low-grade inflammation throughout the body (systemic) is associated with the development of diseases such as cancer, type 2 diabetes, and heart disease. For example, it is theorized that the buildup of inflammatory cells in blood vessels could eventually damage tissue and cause plaque formation. There is also evidence that poor diet significantly affects cytokine levels and chronic inflammation through changes in gut microbiota, revealed by inflammatory blood markers like C-reactive protein (though most reactive markers are more reflective of acute versus chronic inflammation).4, 5

It is estimated that as much as 60 percent of all chronic diseases could be prevented by healthy eating choices and lifestyle behaviors.6

A traditional Mediterranean-style diet is the most researched diet in the world. It has been shown useful for reducing inflammation, conferring protection against many conditions such as cardiovascular disease, type 2 diabetes, certain cancers, and Parkinson’s and Alzheimer’s disease. “Traditional” meaning it is centered on whole versus processed foods, and shared with family/friends (i.e., eaten slowly). The diet focuses on fresh fruits and vegetables, whole grains, and legumes; nuts, seeds, and olive oil for fats (the diet is 30-50 percent fat); fish, white meat, eggs, fermented dairy (yogurt, cheese); small amounts of desserts; and red and processed meat.6

Researchers believe it is the overall diet that reduces inflammation and not any one aspect.

The Dietary Approaches to Stop Hypertension (DASH) diet, is another practical eating approach, particularly in light of hypertension and COVID-19. Aimed at those who need to reduce blood pressure, the diet is similar to the Mediterranean, style emphasizing plant-based foods (vegetables, fruits, legumes) and low-fat dairy, and moderate whole grains, fish, poultry, and nuts. The diet is designed to reduce sodium intake while increasing blood pressure moderating foods high in potassium, calcium, and magnesium. Over time, this eating approach can reduce systolic blood pressure by as much as 14 points.7

FOOD AND IMMUNITY

Can we fortify our immune system against foreign bodies like coronavirus through diet?

Harvard Health says that because the immune system is a “system” that requires “balance and harmony,” the jury is still out as to whether we can enhance it. “Which cells should you boost, and to what number? No one knows how many cells or what the best mix of cells the immune system needs to function at its optimum level.”9

Nevertheless, they say healthy eating and other factors still play a vital role in maintaining that balance. It’s well established that malnourished people are more susceptible to a communicable disease, though a causal relationship between malnutrition and increased susceptibility to infectious disease, they say, has yet to be elucidated. There is some animal research that deficiency in zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E affects immunity. However, its impact on animal health and how this applies to humans is less clear.

A systematic review of 82 studies suggests that 1-2 grams/day of vitamin C, 400 IU/day of vitamin D, zinc supplements/lozenges within 24 hours of symptoms onset, and echinacea (2,400 mg/day over four months) may be effective at preventing and reducing the intensity of common colds. According to the researchers, the evidence is “so interesting that common cold patients may be encouraged to try them for preventing and treating their colds,” though more research is needed.10

Harvard scientists aren’t against taking a daily multiple vitamin/mineral supplement, especially for people averse to eating a healthy diet, though they advise against mega doses.

But they frown on taking supplements in an attempt to boost immunity. “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.”

ANTI-INFLAMMATORY LIVING

Besides eating a colorful and balanced diet, health experts echo a familiar mantra: regular physical activity, reducing psychosocial stress, 7-9 hours of sound sleep, controlling weight, and spending time with loved ones. Additionally, watching for known environmental and industrial toxins that can trigger inflammation is advisable.5, 6

With more time spent at home these days, eating healthier or increasing, physical activity may be more challenging. Generally, it takes 21 days to form a habit and 90 days to
make it a lifestyle.

To help you form healthy habits, consider the Stages of Change approach outlined by the National Institute of Diabetes and Digestive and Kidney Diseases.11 H
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1. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) - People Who Are at Higher Risk for Severe Illness.

2. Mento, T. (2020, May 30).Hypertension Continues To Be Top Underlying Health Condition Among Local COVID-19 Deaths. KPBS.

3. Szalay, J. (2018, October 19). What Is Inflammation? Live Science.

4. Shivappa, N. (2019, July). Diet and Chronic Diseases: Is There a Mediating Effect of Inflammation? Nutrients, 11(7), 1639.

5. https://factor.niehs.nih.gov/2020/1/papers/inflammation/index.htm

6. Adapted from University of Wisconsin Integrative Health. The Anti-Inflammatory Lifestyle [Patient handout].

7. Mayo Clinic. DASH diet: Healthy eating to lower your blood pressure.

8. Adapted from Harvard Health Publishing. (2014, June [updated 2018, November 7]). Foods that fight inflammation. Harvard Women’s Health Watch.

9. Harvard Health Publishing. (2014, September [updated 2020, April 6]). How to boost your immune system.

10. Rondanelli, M.; Miccono, A.; Lamburghini, S.; et al. (2018, April 29). Self-Care for Common Colds… Evidence-Based Complimentary and Alternative Medicine, 5813095. [Epub].

11. https://www.niddk.nih.gov/health-information/diet-nutrition/changing-habits-better-health