NUTRITIONAL SUPPORT FOR YOUR IMMUNITY AND CORONA VIRUS (SARS-COV-2)

NUTRITIONAL SUPPORT FOR YOUR IMMUNITY AND CORONA VIRUS (SARS-COV-2)

Background


We have all now become familiar with the novel coronavirus, SAR CoV-2, which was first identified in Wuhan, China in late 2019 as the cause of coronavirus disease 2019 (COVID-19). Coronaviruses were identified as human pathogens in the 1960s and infect both humans and a variety of animals, including birds and mammals.
Typically the illness presents in humans as a respiratory or gastrointestinal infections and symptoms can range from a common cold to more severe lower respiratory infections. More recent observations show that in addition, changes in blood platelets triggered by COVID-19 could contribute to the onset of heart attacks, strokes, and other serious complications in some patients (1).

Take control of our Health
There is currently so much information circulating about risk factors, proposed treatments and patient outcome it can seem overwhelming to say the least! So if there is a second wave what are the main actions we can make to take control of our health and potentially minimise some of the risk outside necessary government guidelines for social distancing, wearing a mask and shielding? A second wave during the flu-season means we should really act now if we want to optimise health, lower inflammation in the body and boost the immune system. This Is the ideal time to focus on nutritional strategies, natural supplementation and lifestyle changes as we are still in the Summer and positive behavioural changes are typically easier in the long, sunny days when we are feeling more optimistic. Right now, positive changes can also help focus our minds and if we start taking control of our health we can  feel more empowered in these turbulent times.

IMMUNE RESPONSE


One of the key areas we consider with covid-19 is the immune response. Many of us will have been made aware or have heard of the overactive inflammatory response or ‘cytokine storm’, associated with the virus. Cytokines are small proteins which are released by different cells in the body, including the immune system and  they coordinate the body’s response to infection. This action also triggers inflammation which is a natural and healthy response as long as it is not excessive.
In some covid-19 patients excessive levels of cytokines are released which activate more immune cells and this results in hyperinflammation (2). Ultimately, this can lead to severe outcomes and even death. Unfortunately as we get older, or because of certain underlying health conditions, our immune system may not be as strong as a younger person. Older people in general have less effective immune reactions to the virus and worse outcome but we must be aware that patients under 65 with certain underlying health conditions are also at moderate – high risk (3).
There is a plethora  of research now on how the immune system responds to the corona virus but we need to recognise that it is complex field and there are many areas we do not fully understand. While developing new drugs or repurposing old drugs is the centre stage for medical treatments we do need to also integrate the role of nutrition and lifestyle in optimising immunity. Within Nutritional Therapy when we think about targeting the immune system we need to create a nutrient dense and metabolically appropriate diet, reduce inflammatory pathways and focus on the gut!

The Immune System and The Gut. What is the connection?

Often we hear, ‘we are what we eat’ and never more so than when it comes to our immune system and diet. A large percentage of our immune system is in the gastrointestinal tract. To have a healthy immune system we require a first line response from our ‘innate’ immune system which consists of phagocytes, neutrophils, mast cells etc. This attacks the invading pathogens. Secondly, we need our ‘adaptive’ immune system to follow with both T and B cells required to recognise the pathogen and remember it for future exposure. (4).
When the immune system is activated by an infection, energy is needed for both innate and adaptive response. Both undernutrition and overnutrition can have an adverse effect by not supplying enough of the right nutrients or creating inflammation through over consuming foods like refined carbs, added sugar, trans fats and too much saturated fats (5). Therefore, we need optimum nutrition from the right quantity and quality of foods.
One positive way we can boost our immune response through the gut is feeding our gut bacteria. The gut microbiome interacts continuously with the immune system and by eating a rich plant-based diet and plenty of healthy fibre we are creating a food source for gut bacteria and generating a healthy community of gut bacteria (6). The immune system in the gut can be further supported by using probiotics or probiotic foods especially if we have been suffering gut problems, have been on antibiotics, have malabsorption issues or suffer from a small-intestinal-bacterial overgrowth (SIBO).

Diet, Inflammation and Immunity

There are a number of factors which make someone high or moderate risk for covid-19. These are highlighted by the NHS and those in this category will have been made aware of strategies which must be taken to reduce the risk of catching the virus and should be adhered to.
There are also actions we can also take regarding diet and nutrition to reduce inflammatory responses in the body which impair immunity. This in particular applies to those who are suffering from any type of metabolic disorder as studies are demonstrating the link between Metabolic Syndrome and the progression and overall prognosis from covid-19. (7,8).
‘’Metabolic syndrome is the medical term for a combination of diabetes, high blood pressure (hypertension) and obesity. It puts you at greater risk of getting coronary heart disease, stroke and other conditions that affect the blood vessels (NHS, 2020)
The drivers behind Metabolic Syndrome are central obesity (abdominal fat), high blood pressure, insulin resistance and low HDL which is the healthy form of cholesterol to protect from heart disease(8). Diet and lifestyle interventions are key to managing and controlling Metabolic Syndrome and can reduce inflammatory markers. Constant chronic inflammation are integral to obesity, diabetes, hypertension and cardiovascular disease and pose a problem through delayed, and inferior immune response (9).
Clear evidence has been provided that Diabetes Mellitus is one of the leading risk factors for COVID-19. It should be noted that even outside covid-19 we are experiencing a worldwide epidemic of Diabetes with an estimated 463 million adults (20–79 years) in 2019 with the condition and by 2045 this will rise to approx. 700 million (10). This is a shocking figure but given the current pandemic more attention should be paid to diet and lifestyle driven disorders such as diabetes. It is time to be more aware of these metabolic disorders and look for signs and markers of a prediabetic state which can both lead to diabetes but can also impair immune response.

Dietary Strategies for Immunity

First and foremost, the evidence shows that eating a standard Western diet increases the risk of Metabolic Syndrome (11). A standard Western diet is characterised by a high intake of processed meat, refined carbohydrates, fried food, added sugars, red meat, diet soda and possibly too much dairy (12).
The quality and quantity of food matters! The right balance of foods and the right quantity can positively impact insulin secretion, insulin sensitivity, oxidative stress and inflammation which can all impact immune response (13).  A diet to balance blood sugars, lower cholesterol, increase insulin sensitivity and improve metabolic health can generally be summed up as rich in fruits, vegetables, legumes and whole grains, fish, nuts, and low-fat dairy products.

Basic guidelines for better metabolic health and immune function

1. If you are overweight or obese then weight loss is essential and making sure that you can do this using a sustainable, long term plan.

2. Regulate blood sugars! This obviously applies to all metabolic conditions but constantly fluctuating blood sugar levels will contribute to inflammation.

3. Eating a low glycemic diet can help reduce fluctuations in blood sugars.

4. Make sure your cholesterol is in a healthy range.

5. Have plenty of healthy fibre to maintain good gut healthy to promote better immunity.

6. Eat the ‘rainbow’, literally! This ensures plenty of antioxidants and phytonutrients which are anti-inflammatory.

Eating Low Glycemic

To improve your metabolic state even if you are not obese, diabetic or suffering from hypertension it is best to focus on foods which have a low glycemic load.
‘’The glycemic load (GL) of food is a number that estimates how much the food will raise a person’s blood glucose level after eating it’’
Overall they can help by;
• Keeping sugar levels from going too high
• Reducing hunger between meals
• Reducing the body’s need for insulin – reducing insulin resistance
• Achieving weight loss
Carbohydrates which are high glycemic such as white bread, white pasta, white rice, sugar, sugary drinks, cakes, sweets, crisps etc can negatively impact health by directing the body to store more calories as fat, increase hunger and lower energy expenditure. Carbohydrates which are low glycemic load also have higher fibre content and this is really important when looking at lowering cholesterol levels as well.

 

Choose from Low-Moderate Glycemic Foods.
• Apples, apricots, blackberries, blueberries, cherries, cranberries (not dried), grapefruit, peaches, pears, prunes, plums, raspberries, tangerine, strawberries, banana, figs, grapes, kiwi, mango, oranges.
• Asparagus, artichoke, avocado, broccoli, cabbage, cauliflower, celery, cucumber, eggplant, greens, lettuce, mushrooms, peppers, tomatoes, okra, onions, spinach, summer squash, zucchini, turnips, beets, carrots, Sweet potato, yam, corn on the cob.
• Black eyed peas, butter beans, chick-peas, green beans, kidney beans, pinto beans, lentils, lima beans, navy beans, snow peas, hummus.
• Almonds, peanuts, pecans, sunflower seeds, hazelnuts, olives walnuts, cashews, macadamia.
• Sunflower seeds, pumpkin seeds, hemp seeds, chia seeds, sesame seeds.
• Whole grains, barley, rye, bulgur, wild rice, wheat tortilla, wheat pasta, spelt, quinoa, long-fermented sourdough bread.
• Organic skim milk, soy milk, almond milk, organic low-fat cheese, organic yogurt (low fat or greek).
• Organic or pasture fed lean red meat, white fish and oily fish (3 times a week), organic skinless chicken and turkey, shellfish, organic eggs.

When it comes to grains it is important to also consider ‘’how much?’’. A person’s carb needs vary with their activity level, weight, health goals, and other factors. For those with Diabetes eating a low carb diet can really help, and for someone who has signs of prediabetes lowering your carb intake can also be really beneficial. If you are training regularly you can increase carbohydrate levels but for most of us who are sedentary we eat too many carbs and lowering our carb intake may be beneficial for overall metabolic health.

FATS

It is important to consider fats within the role of metabolic health and as potential contributors to inflammation which can again impair our immune function. Evidence based research looking at metabolic disorders consistently show we should reduce Trans Fats and foods high in saturated fatty acids (SFA). This should be applied in conjunction with an increase in polyunsaturated fatty acids (PUFA) and monounsaturated fats (MUFA). Having healthy PUFA and MUFA in our diet is also helpful for reducing inflammation.

 

Reduce Foods high in Saturated Fats
• milk and white chocolate, toffee, cakes, puddings and biscuits
• pastries and pies
• fatty meat, such as lamb chops
• processed meat, such as sausages, burgers, bacon and kebabs
• butter, lard, ghee, dripping, margarine, goose fat and suet
• coconut and palm oils and coconut cream
• full fat dairy products such as cream, milk, yogurt, crème fraiche and cheese
It should be noted however, that foods high in saturated fats such as coconut oil, red meat etc can be used as part of a healthy ketogenic diet.

 

Increase Foods High in Polyunsaturated Fats Primarily from Omega 3 Source
• Sunflower seeds.
• Flax seeds or flax oil.
• Pine Nuts
• Chia Seeds
• Fish, such as salmon, sardines, mackerel, herring, albacore tuna, and trout.
• Walnuts 

 

Increase sources of Mono-unsaturated Foods.
• Nuts
• red meat
• high-fat fruits such as olives and avocados
• Sunflower oil contains as much as 85% MUFA
• Extra virgin olive oil is about 75% MUFA

Supplements for Immunity

There are many supplements and alternative treatments which are being promoted to both prevent and treat SAR CoV-2. However, we must understand that there is a lack of robust trails to establish how effective they are against the virus itself. This does not discount their role in a holistic strategy to boost immunity and reduce inflammation which can worsen symptoms.

Vitamin D

Vitamin D has been shown in preliminary studies to be lower in people who are more likely to test positive for SAR CoV-2 and have more severe symptoms (14). It has been used in moderate doses to reduce the risk of respiratory infections in adults and children who are deficient in vitamin D (15). It is therefore important to know if you are at risk of being deficient in vitamin D and certain sections of the population are more at risk.
Who May be at Risk of Vitamin D Deficiency?

According to national surveys in the UK, across the population approximately 1 in 5 people have low vitamin D levels (defined as serum levels below 25 nmol/L) (16)
There are different requirements for groups who are likely to be deficient according to the NHS below (17). For infants and young children the following advice is recommended by the NHS.

• breastfed babies from birth to 1 year of age should be given a daily supplement containing 8.5 to 10 micrograms of vitamin D to make sure they get enough.

• formula-fed babies should not be given a vitamin D supplement until they’re having less than 500ml (about a pint) of infant formula a day, as infant formula is fortified with vitamin D.

• children aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin D
For adults risk of deficiency is highest in those that have limited sun exposure such as the elderly who are housebound or in a care home, those who cover their skin when outdoors and those with darker skin. NHS recommendations are to supplement 10mcg of vitamin D throughout the year. This is a general recommendation but it is also important to consider diet and try to maintain some sun exposure.
For most of us we should be able to maintain vitamin D levels from March until September from good sun exposure and diet. Sun exposure recommendations state that 30 min exposure with no sunscreen on hands, arms, legs and face at least 3 times a week is sufficient. However, from September to early March we DO NOT get enough vitamin D from sunlight (17). Therefore, we must consider diet and supplementation as essential for maintaining adequate levels. For those who are vegetarian and vegan this is a particular problem and can only really be addressed through supplementation.

Dietary Sources
• oily fish – such as salmon, sardines, herring and mackerel.
• red meat.
• egg yolks.

Some foods are fortified with vitamin D but it is better to focus on real foods first.

Outside the NHS recommendations which are there to ensure adequate levels, research has shown that autoimmune diseases (Type 1 diabetes, RA, Lupus, Thyroid disease, Hashimotos disease etc.) demonstrate a predisposition for vitamin D deficiency and downstream this also alters the microbiome and integrity of the gut (18). Vitamin D overall shows a role as an immunoregulator for conditions which are autoimmune related and this is important when considering covid-19. Conditions where vitamin D deficiency can occur may require higher levels of supplementation than a normal healthy person and should be discussed with a professional practitioner.

Studies are also identifying inflammation and a dysregulated immune responses following covid-19 and this can then lead to autoimmune and autoinflammatory conditions (19).

Test for Vitamin D
If you are someone who may be at high risk for vitamin D deficiency then ask your GP for a blood test or if this is not possible then speak to your Nutritional Therapist about a low-cost home test for vitamin D. 

 

Summary

Vitamin D seems to be critical for preventing inflammation which can cause more severe symptoms from covid-19 and seem to be an absolute essential therapy for those who are high risk. So, as the sun is out make the most of it and apply caution in full day time sun. Look to diet as a way to support us through the Winter months but we ALL should supplement from September to March.
Brands to look for are BetterYou which is an oral spray and also is available with additional vitamin K2. Other brands are Cytoplan, Pharma Nord and Thorne and ideally make sure it is in he form of vitamin D3.

Zinc

Zinc has also received a significant amount of attention due to it’s well established anti-viral role in preventing the replication of corona viruses in cells (20). It has traditionally been used to reduce the severity of colds caused by viruses and is involved in the regulation of the innate and adaptive immune responses (21). Furthermore, deficiency of zinc can lead to a worse outcome from bacterial infections and sepsis (22). SARS CoV-2 infection often leads to secondary bacterial infections and sepsis can occur in severe cases.
Research has recently acknowledged that zinc supplementation may be of benefit for prophylaxis and treatment of COVID-19 and as an adjacent therapy alongside other medical treatments (23,24). Similar to vitamin D it is also crucial to identify if someone is as risk of deficiency so that supplementation is applied appropriately.

 

Who may be at risk from Zinc Deficiency?
This is not a deficiency which receives as much attention as vitamin D yet there are conditions where zinc deficiency may occur.
Ulcerative Colitis
Chrons’ Disease
Short Bowel Disease
Chronic Liver Disease
Chronic Renal Disease
Sickle Cell Disease
Diabetes
Chronic Diarrhea
Pregnant and Lactating Women
Alcoholics
Vegetarians and Vegans
Eating a diet high in plant phytates has been demonstrated to reduce the bioavailability of zinc and would be important to consider as a standard supplement for those eating primarily a vegan or vegetarian diet (25). 

 

Dietary Sources of Zinc
Clams, oysters, lobster, crab
Dark meat on chicken
Beef
Cashew, almonds, pumpkin seeds
Chickpeas, kidney beans
Oatmeal
Milk, yoghurt and cheese
Mushrooms
Wholegrains

Testing for Zinc Deficiency
There are numerous functional tests available to assess zinc levels but this should ideally be done alongside copper and other minerals. Speak to your Nutritional Therapist about testing.

 

Summary
Although there is lack of definitive evidence looking at the benefits of zinc supplementation and covid-19, the research to date highlights a key role for zinc and deficiency could be a real game changer in outcome. For those who are at risk of deficiency dietary measures to really up your intake are the first strategy but if you are vegetarian or vegan then a supplement is worth investing in. Zinc lozenges have been highlighted for use by a number of trained therapists and it can be used as a first line protocol to specifically target the upper respiratory airways. They should be used at the very first sign of infection to be effective as they are not useful later in the infection. HOWEVER, as they contain a high dose of zinc they should not be used for more than a week. Brands to look for are Lamberts and Life Extension.

VITAMIN C

Vitamin C is best known for its antioxidant properties as it is able to scavenge damaging reactive oxygen species and protects the body’s cells and tissues from oxidative damage (26). It has numerous other functions in the body, many of which support healthy immune function. During infection, vitamin C levels can become depleted and as the severity of the infection increases, so does the requirement for vitamin C . In severe cases, this may require intravenous administration to achieve high enough levels in the body to assist in recovery from infections. Studies highlight its ability in reducing the severity of a common cold and it has also been demonstrated to be useful in the treatment of pneumonia (27) which is something we should consider as the virus can spread to the lungs and cause pneumonia.


Symptoms of vitamin C deficiency can start to appear after 8 to 12 weeks. Early signs include a loss of appetite, weight loss, fatigue, irritability, and lethargy (28). Therefore, it is crucial to maintain healthy levels in the body to avoid deficiency and to ensure the body has extra stores to effectively fight infection if infection occurs.
So what is the research to date? We have to be clear that the use of vitamin C in trials for covid-19 has been primarily for severe cases through IV infusions in trials in China, Italy and the USA but we are still awaiting data on the actual results.

Who may be at risk of Vitamin C Deficiency?
Having a poor quality diet lacking in fresh fruits and vegetables.
Anorexia and other eating disorders.
Restrictive diets (if you are following an elimination diet please ensure you have professional nutritional guidance).
Excessive use alcohol or illegal drugs.
IBD (Chrons Disease, Ulcerative Colitis impair absorption of nutrients)
Smokers. 

Dietary sources 
Guava, papaya, oranges, tomatoes, strawberries, sweet pepper, grapefruit, berries, pineapple, broccoli, garlic Brussel sprouts, kiwi, mango, lemon, lime, potatoes.

Testing for Vitamin C Deficiency
Private lab tests are the only route to testing vitamin C status as this is not normally available through your GP.

Supplementing Vitamin C
It can be useful to increase vitamin C if you have signs of a cold, sore throat, cough, headache, aches and pains or a runny nose. Use on a daily basis but split the dose through the day for best effect. High doses can cause stomach cramping and diarrhea. Depending on size and weight, 1000-2000mg of vitamin C may be helpful to support immune function.

Summary
Vitamin C is without doubt an important tool in the treatment of covid-19 and can be used as a powder or capsule. Choose from brands such as Biocare in the form of magnesium ascorbate which may be gentler on the stomach and also contains a valuable extra boost of magnesium. Other brands which deliver a high quality vitamin C supplement are Viridian in the form of organic acerola cherry powder with additional bioflavonoids.  Start with a half dose and increase slowly to monitor effect; do not exceed dose as this can cause cramping or diarrhea. Everyone is different with bowel tolerance for vitamin C so gradually increasing the dose allows more effective control.

VITAMIN A

Vitamin A was initially coined “the anti-infective vitamin’’. It is a  fat-soluble compounds found as retinol in animal products and as provitamin A carotenoids in fruit and vegetables. The three active forms of vitamin A in the body are retinol, retinal, and retinoic acid. Vitamin A plays an important role in supporting T Cells which are a white blood cell needed to identify pathogens (like viruses or infectious bacteria) and is critical to effective immune function (29). It has demonstrated a therapeutic effect in the treatment of various infectious diseases and viral infections especially in children where deficiency is evident (30). Vitamin A deficiency is associated with increased susceptibility to infections.

Who may be at risk of Vitamin A deficiency?
Inadequate intakes of vitamin A from animal products (as preformed vitamin A) and fruit and vegetables (as provitamin A carotenoids).
IBD, Chrons Disease, Celiac disease
Conditions where there is malabsorption of fat e.g. Cystic Fibrosis

Dietary Sources
Preformed vitamin A as retinol is found in dairy products, fortified cereal, liver, and fish oils. Plant sources as Provitamin carotenoids are orange and green vegetables, such as sweet potato and spinach.

Testing for Vitamin A Deficiency
May be carried out for those with specific bowel conditions or where fat malabsorption is evident through a medical practitioner. Private lab tests are available through a Nutritional Therapist. 

Supplementing
Vitamin A in high doses is toxic so supplementation should be within safe limits. Requirements for adults 19-64 is 0.7mg a day for men and 0.6mg a day for women (31). Supplementing may be as preformed vitamin in the form of retinyl acetate or retinyl palmitate or as part of a multi-vitamin in which case it may also contain provitamin A carotenoid as beta-carotene. Doses can vary from 2,500–10,000 IU but it absolutely crucial to consider the amount available through diet before supplementing. Look for brands such as Biocare, Viridian or Garden of Life for single formula or as part of a multi-vitamin/mineral.

 

Summary
As an effective way to maintain good levels of vitamin A, dietary sources are absolutely necessary. With regard to liver a max of 100g per week should meet vitamin A requirement in an adult and supplementation would NOT be recommended in conjunction.

Dietary Phytochemicals

Dietary phytochemicals are found in plant-based foods such as fruits, vegetables and grains and are associated with positive health outcomes especially with regard to Metabolic Syndrome (32, 33) and  especially diabetes and obesity (34). Many dietary phytochemicals also have strong anti-inflammatory activity and may help regulate how fat cells grow to prevent obesity (35).
In the search for antivirals to shorten patient recovery times from COVID-19, a class of phytochemicals from foods called flavonoids have been investigated for therapeutic use (36). The most effective to date have been identified as  amentoflavone, gallocatechin gallate, diosmin, epigallocatechin gallate, hidrosmin, catechin gallate, elsamitrucin, pectolinaren, quercetin, and isoquercetin. Research has not shown effective dosages for these flavonoids but thankfully they are available in foods which we can easily consume.

Dietary Sources

Green tea, black tea, coffee, red wine
Onions, apples, grapes, berries, broccoli, citrus fruits, cherries, red cabbage, parsley, celery, red chilli, turnip greens, sweet potato, spinach.
Quinoa
Capers
Moderate amounts of soya in the form of tofu and tempeh

Supplementation

There are numerous singular or complex supplements which contain active flavonoids but quality is difficult to determine and there are no recommended doses for fighting viral infections. It is important to recognise the need for a wide range of food sourced phytochemicals which include flavonoids in a healthy diet. Use plenty of fresh herbs, include green tea on a daily basis, use fresh turmeric in smoothies and cooking, buy organic fruit and vegetables and eat as many colourful foods as you can. If supplementing then use during a period where the body needs extra support but do not use long term.

Probiotics

There is scarce data available on the effect of COVID-19 on the intestinal microbiota although a small case series from China revealed that some patients with COVID-19 showed microbial dysbiosis with decreased Lactobacillus and Bifidobacterium (37). However, there is a wealth of research to demonstrate that the microbiome is known to influence acquired immunity in various ways.  Of particular interest with relation to SARS CoV-2 is the role of the T-helper 1 cell (Th1) which is essential for the immune response against viral infections (38). Ultimately we need to consider the role of the gut in determining lung health as demonstrated through the connection with respiratory disease (39).

Supplementation
Having a healthy gut microbiome as we mentioned earlier is vital for overall health, and while food is one part of the equation, for some people additional supplementation with probiotics may help support healthy immune function. Supplementation of probiotics has no specific targets for dose, strain or timing based on research and this is where recommendations are perhaps difficult to determine. As a general note start by including foods with live cultures in your diet such as sauerkraut, kimchi, kefir and kombucha alongside a varied plant-based diet. For probiotic supplements, a live culture containing a multi-strain may be beneficial but if in doubt talk to your Nutritional Therapist for an individual plan regarding probiotic use.

SLEEP

Sleep has an important influence on our immune function as sleep deprivation may increase the risk of inflammation in the body, which in turn increases our susceptibility to viruses and other diseases. Good sleep hygiene is necessary for most people as we have become more reliant on screens both during the day and just before bed. To achieve consistent sleep hours it is best to turn off screens, make sure the room is cool, quiet, and dark, and avoid alcohol and any stimulants like coffee or tea before bed. For some people it is best to have coffee only in the morning as it can still cause raised cortisol at night leading to poor sleep. A book is better for bedtime or try listening to a sleep app for quiet music to let the mind unwind.

Exercise

Moderate, regular physical activity can help to boost immune system function by raising levels of white blood cells and antibodies, increasing circulation, and decreasing stress hormones. Try to establish an exercise program to improve both cognitive and physical resilience. Using exercise to improve our mental well-being during the pandemic is crucial for reducing stress and keeping the whole family moving is one way to stay positive!

ORAL HEALTH

Poor oral hygiene and periodontal disease may contribute to a high bacterial load in the mouth and cause post-viral complications (40). The oral cavity has the second largest and diverse microbiota after the gut containing over 700 species of bacteria and numerous microorganisms which include fungi, viruses and protozoa (41). It is not just critical for oral health but also systemic health as infection can spread from the mouth to lungs. To maintain good oral hygiene, brushing our teeth is step one but other actions can be taken to really promote BETTER oral hygiene and microbiome balance. A daily mouth cleanse with coconut oil to deep clean the mouth may be really beneficial. Other daily remedies to balance bacteria in the oral cavity are drinking green tea, eating plenty of natural antimicrobials such as Garlic, Rosemary, Thyme, Basil, Oregano, Cinnamon, Black Pepper and add in your probiotic foods such as kefir, live yogurt, fermented foods. Cleanse the mouth every morning and also maintain a healthy pH in the mouth by drinking warm water and lemon or a small teaspoon of apple cider vinegar first thing before eating breakfast.
This is just a summary of diet, supplement and lifestyle techniques we can apply for ourselves and all the family. Making improvements to our metabolic health will have longer term benefits even when we can finally realise a time when SARS CoV-2 is not the global threat that we face today. Ultimately, making changes now makes us more resilient both physically and mentally and puts the foundation of health in our hands so we can move forward with the challenges of life.

References
1. Manne, B. K. et al. (2020) ‘Platelet Gene Expression and Function in COVID-19 Patients’, Blood. NLM (Medline). doi: 10.1182/blood.2020007214.
2. Childs, C. E., Calder, P. C. and Miles, E. A. (2019) ‘Diet and immune function’, Nutrients. MDPI AG. doi: 10.3390/nu11081933.
3. Clark, A. et al. (2020) ‘Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study’, The Lancet. Global health. NLM (Medline), 0(0). doi: 10.1016/S2214-109X(20)30264-3.
4. Clark, A. et al. (2020) ‘Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study’, The Lancet. Global health. NLM (Medline), 0(0). doi: 10.1016/S2214-109X(20)30264-3.
5. Bourke, C. D., Berkley, J. A. and Prendergast, A. J. (2016) ‘Immune Dysfunction as a Cause and Consequence of Malnutrition’, Trends in Immunology. Elsevier Ltd, pp. 386–398. doi: 10.1016/j.it.2016.04.003.
6. Tomova, A. et al. (2019) ‘The effects of vegetarian and vegan diets on gut microbiota’, Frontiers in Nutrition. Frontiers Media S.A., p. 47. doi: 10.3389/fnut.2019.00047.
7. Costa, F. F. et al. (2020) ‘Metabolic syndrome and COVID-19: An update on the associated comorbidities and proposed therapies’, Diabetes and Metabolic Syndrome: Clinical Research and Reviews. Elsevier Ltd, pp. 809–814. doi: 10.1016/j.dsx.2020.06.016.
8. Marhl, M. et al. (2020) ‘Diabetes and metabolic syndrome as risk factors for COVID-19’, Diabetes and Metabolic Syndrome: Clinical Research and Reviews. Elsevier Ltd, 14(4), pp. 671–677. doi: 10.1016/j.dsx.2020.05.013.
9. Ellulu, M. S. et al. (2017) ‘Obesity & inflammation: The linking mechanism & the complications’, Archives of Medical Science. Termedia Publishing House Ltd., 13(4), pp. 851–863. doi: 10.5114/aoms.2016.58928.
10. International Diabetes Federation – Facts & figures (no date). Available at: https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html (Accessed: 6 July 2020).
11. Kopp, W. (2019) ‘How western diet and lifestyle drive the pandemic of obesity and civilization diseases’, Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. Dove Medical Press Ltd., 12, pp. 2221–2236. doi: 10.2147/DMSO.S216791.
12. The Role of Diet in Metabolic Syndrome | National Institutes of Health (NIH) (no date). Available at: https://www.nih.gov/news-events/nih-research-matters/role-diet-metabolic-syndrome (Accessed: 5 July 2020).
13. Xu, H. et al. (2019) ‘Etiology of metabolic syndrome and dietary intervention’, International Journal of Molecular Sciences. MDPI AG. doi: 10.3390/ijms20010128.
14. Strong circumstantial evidence suggests vitamin D could improve COVID-19 outcomes (no date). Available at: https://www.diabetes.co.uk/news/2020/05/strong-circumstantial-evidence-suggests-vitamin-d-could-improve-covid-19-outcomes/ (Accessed: 13 July 2020).
15. Jha, R. S. (2016) ‘Role of vitamin D supplementation in lung function testing and exercise capacity’, in European Respiratory Journal. European Respiratory Society (ERS), p. PA4141. doi: 10.1183/13993003.congress-2016.pa4141.
16. New advice on vitamin D – British Nutrition Foundation (no date). Available at:https://www.nutrition.org.uk/nutritioninthenews/new-reports/983-newvitamind.html?
17. Vitamins and minerals – Vitamin D – NHS (no date). Available at: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ (Accessed: 13 July 2020).
18. Yamamoto, E. A. and Jørgensen, T. N. (2020) ‘Relationships Between Vitamin D, Gut Microbiome, and Systemic Autoimmunity’, Frontiers in Immunology. Frontiers Media S.A., p. 3141. doi: 10.3389/fimmu.2019.03141.
19. Galeotti, C. and Bayry, J. (2020) ‘Autoimmune and inflammatory diseases following COVID-19’, Nature Reviews Rheumatology. Nature Research, pp. 1–2. doi: 10.1038/s41584-020-0448-7.
20. Viguiliouk, E. et al. (2019) ‘Imported from https://academic.oup.com/advances/advance-article/doi/10.1093/advances/nmz022/5521427’, Advances in Nutrition. Oxford Academic, 10(Supplement_4), pp. S308–S319. doi: 10.1093/ADVANCES.
21. Rondanelli, M. et al. (2018) ‘Self-Care for Common Colds: The Pivotal Role of Vitamin D, Vitamin C, Zinc, and Echinacea in Three Main Immune Interactive Clusters (Physical Barriers, Innate and Adaptive Immunity) Involved during an Episode of Common Colds—Practical Advice on Dosages and on the Time to Take These Nutrients/Botanicals in order to Prevent or Treat Common Colds’, Evidence-based Complementary and Alternative Medicine : eCAM. Hindawi Limited, 2018. doi: 10.1155/2018/5813095.
22. Gammoh, N. Z. and Rink, L. (2017) ‘Zinc in infection and inflammation’, Nutrients. MDPI AG. doi: 10.3390/nu9060624.
23. Rahman, M. T. and Idid, S. Z. (2020) ‘Can Zn Be a Critical Element in COVID-19 Treatment?’, Biological Trace Element Research. Humana Press Inc. doi: 10.1007/s12011-020-02194-9.
24. Zinc – Health Professional Fact Sheet (no date). Available at: https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/ (Accessed: 6 July 2020).
25. Gupta, R. K., Gangoliya, S. S. and Singh, N. K. (2013) ‘Reduction of phytic acid and enhancement of bioavailable micronutrients in food grains’, Journal of Food Science and Technology. Springer India, pp. 676–684. doi: 10.1007/s13197-013-0978-y.
26. Hemilä, H. and Douglas, R. M. (no date) ‘Vitamin C and acute respiratory infections’. International Union Against Tuberculosis and Lung Disease.
27. Vitamin C intake and susceptibility to pneumonia : The Pediatric Infectious Disease Journal (no date). Available at: https://journals.lww.com/pidj/Citation/1997/09000/Vitamin_C_intake_and_susceptibility__to_pneumonia.3.aspx (Accessed: 6 July 2020).
28. Brickley, M. and Ives, R. (2008) ‘Vitamin C Deficiency Scurvy’, in The Bioarchaeology of Metabolic Bone Disease. Elsevier, pp. 41–74. doi: 10.1016/b978-0-12-370486-3.00004-4.
29. Huang, Z. et al. (2018) ‘Role of Vitamin A in the Immune System’, Journal of Clinical Medicine. MDPI AG, 7(9), p. 258. doi: 10.3390/jcm7090258.
30. Thorne-Lyman, A. and Fawzi, W. W. (2012) ‘Vitamin A supplementation, infectious disease and child mortality: a summary of the evidence’, Nestlé Nutrition Institute workshop series. Nestle Nutr Inst Workshop Ser, pp. 79–90. doi: 10.1159/000337445.
31. Grune, T. et al. (2010) ‘β-Carotene Is an Important Vitamin A Source for Humans’, The Journal of Nutrition. Oxford University Press (OUP), 140(12), pp. 2268S-2285S. doi: 10.3945/jn.109.119024.
32. Panagiotakos, D. B. et al. (2007) ‘{A figure is presented}The Association between Food Patterns and the Metabolic Syndrome Using Principal Components Analysis: The ATTICA Study’, Journal of the American Dietetic Association. Elsevier, 107(6), pp. 979–987. doi: 10.1016/j.jada.2007.03.006.
33. Sonnenberg, L. et al. (2005) ‘Dietary Patterns and the Metabolic Syndrome in Obese and Non-obese Framingham Women **’, Obesity Research. North American Assoc. for the Study of Obesity, 13(1), pp. 153–162. doi: 10.1038/oby.2005.20.
34. Williams, D. E. M. et al. (1999) ‘Frequent salad vegetable consumption is associated with a reduction in the risk of diabetes mellitus’, Journal of Clinical Epidemiology. Elsevier, 52(4), pp. 329–335. doi: 10.1016/S0895-4356(99)00006-2.
35. Williams, D. E. M. et al. (1999) ‘Frequent salad vegetable consumption is associated with a reduction in the risk of diabetes mellitus’, Journal of Clinical Epidemiology. Elsevier, 52(4), pp. 329–335. doi: 10.1016/S0895-4356(99)00006-2.
36. Peterson, L. (2020) ‘COVID-19 and Flavonoids: In Silico Molecular Dynamics Docking to the Active Catalytic Site of SARS-CoV and SARS-CoV-2 Main Protease’, SSRN Electronic Journal. Elsevier BV. doi: 10.2139/ssrn.3599426.
37. Y Mak, J. W., L Chan, F. K. and Ng, S. C. (2020) ‘Probiotics and COVID-19: one size does not fit all’. doi: 10.1016/S2468-1253(20)30116-3.
38. Probiotics and COVID-19 – Invivo Healthcare (no date). Available at: https://invivohealthcare.com/human-ecology-journal/probiotics-and-covid-19/ (Accessed: 13 July 2020).
39. Enaud, R. et al. (2020) ‘The Gut-Lung Axis in Health and Respiratory Diseases: A Place for Inter-Organ and Inter-Kingdom Crosstalks’, Frontiers in Cellular and Infection Microbiology. Frontiers Media S.A., p. 9. doi: 10.3389/fcimb.2020.00009.
40. Sampson, V., Kamona, N. and Sampson, A. (2020) ‘Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections?’, British Dental Journal. Springer Nature, 228(12), pp. 971–975. doi: 10.1038/s41415-020-1747-8.
41. Deo, P. N. and Deshmukh, R. (2019) ‘Oral microbiome: Unveiling the fundamentals’, Journal of Oral and Maxillofacial Pathology. Wolters Kluwer Medknow Publications, pp. 122–128. doi: 10.4103/jomfp.JOMFP_304_18.



Leave a Reply

Your email address will not be published. Required fields are marked *