COVID-19: Healthy Diet for Primary Prevention

A healthy diet is primary prevention for COVID-19

Dicken Weatherby, N.D. and Beth Ellen DiLuglio, MS, RDN, LDN

The ODX COVID-19 Series

1. COVID-19: The pandemic that has become endemic
2. COVID-19: Overlapping risk factors and chronic disease
3. Nutritional status COVID-19: A covert factor in disease susceptibility
4. COVID-19: Blood chemistry biomarker patterns - Clues and patterns lurking just under the surface
5. COVID-19: Blood chemistry biomarker patterns - Down the research rabbit hole
6. COVID-19: Blood Biomarkers - Neutrophils
7. COVID-19: Blood Biomarkers - Albumin
8. COVID-19: BloodBiomarkers - Cytokines
9. COVID-19: Blood Biomarkers - Interleukin-6
10. COVID-19: Blood Biomarkers - Interleukin-10
11. COVID-19: Blood Biomarkers - Vitamin C
12. COVID-19: Blood Biomarkers - Vitamin D
13. COVID-19: Blood Biomarkers - Zinc
14. Biomarker characteristics and blood type - help sharpen the COVID-19 clinical picture
15. COVID-19: Initial indications and conventional interventions
16. COVID-19: Long-term risk reduction - Naturopathic, functional medicine, and nutrition-based approaches to prevention
17. A healthy diet is primary prevention for COVID-19
18. You should have a gut feeling about COVID-19
19. Beyond dietary food patterns…plant-based compounds may mitigate COVID-19 risk
20. Targeted nutrition support in the battle against COVID-19
21. Targeted nutrition support in COVID-19: Armed with vitamin C
22. Targeted nutrition support in COVID-19: In sync with zinc
23. Targeted nutrition support in COVID-19: Micronutrients and phytonutrients are important players
24. Optimal Takeaways for improving immunity and reducing susceptibility to COVID-19
25. Optimal - The Podcast: Episode 8 -Blood Biomarkers and Risk Factors for COVID-19 and its Comorbidities

Practitioners and patients alike should be aware of the composition of a healthy versus an unhealthy diet and its role in disease prevention or promotion:[i] [ii] [iii] [iv] [v] [vi] [vii]

An umbrella review of published prospective cohort studies and meta-analyses confirm that “healthy dietary patterns may be associated with a lower risk of T2D, COPD, CHD, fracture, depression, and all-cause and CVD mortality.” [viii]

A healthy pattern, in general, includes an abundance of plant-based foods, low-fat dairy, and fish/seafood combined with a sharp reduction in red meat and processed foods. A whole-food, plant-based diet with high-quality protein is widely recommended for the prevention and intervention of chronic diseases such as diabetes, cardiovascular disease, and hypertension.

Such a diet is recommended with regard to COVID-19 as well. Naturopathic, functional medicine and clinical nutrition practitioners recognize that a healthy diet can support the immune system and can reduce the risk of severe COVID-19. Researchers confirm that conclusion.[ix] [x]

Diet is a modifiable risk factor for chronic disease and severe COVID-19. However, general nutrition education is often overshadowed by commercial interests and many individuals are unaware of the components of a healthy diet, despite decades of research.[xi]

A generalized healthy diet and lifestyle pyramid.

Source: Cena, Hellas, and Philip C Calder. “Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease.” Nutrients vol. 12,2 334. 27 Jan. 2020, doi:10.3390/nu12020334  This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.

Healthy dietary pattern:

• An abundance of fruits, vegetables, whole grains, nuts, seeds, beans/legumes, baked root vegetables, soy, fish, poultry, healthy unsaturated oils, olive oil, omega-3 fatty eggs, low-fat dairy, fermented dairy, high fiber, herbs, spices, healthy dark chocolate-based sweets, adequate micronutrients (vitamins, minerals, trace elements, phytonutrients), and purified water.

Unhealthy dietary pattern:

• An abundance of red and processed meats, refined grain products, high-fat dairy, butter, deep-fried foods, fast foods, French fries, trans fats, commercial cakes and snack foods, biscuits, pizza, excess salt, concentrated sweets, and sugar-sweetened beverages.
• A LACK of fresh fruits, vegetables, and whole unprocessed foods.

Interestingly, long-term olive oil consumption, a mainstay of the Mediterranean diet, was noted to have anti-inflammatory effects by modulating communication between the brain, liver, skeletal muscle, and adipose tissue.[xii]

A nationwide cross-sectional study in Luxembourg demonstrated that adherence to a Mediterranean-style diet was significantly associated with reduced levels of LDL cholesterol, apo B, diastolic blood pressure, creatinine, uric acid, and liver enzymes (GGT, AST/GOT, ALT/GPT). [xiii]

The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) dietary patterns are ideal for meeting disease prevention criteria. They may be ideal for use in the general population with modifications as needed for renal function, liver function, or other medical nutrition therapy indications. Similar patterns include the MIND diet, Nordic diet, and traditional Asian diets. [xiv] [xv] [xvi] [xvii] [xviii]
Such patterns help provide the nutrients crucial to supporting immune function and reducing the risk of chronic non-communicable diseases, and in turn, reducing the risk of communicable infectious disease.

The World Health Organization provided modified guidelines during COVID-19 to increase intake of fruits and vegetables (4 servings of fruit, 5 servings of vegetables) and consume adequate whole grains, meats/protein, and beans. Adequate micronutrient intake is imperative as well, particularly vitamins A, C, and D, zinc, and selenium.[xix] Micronutrients are required in relatively small amounts in the body but facilitate the majority of physiological functions including regulation of metabolism, facilitation of growth, generation of energy, and maintenance of cellular function and integrity. [xx]

You are what you eat… it’s best to be a vibrant, energetic, thriving individual instead of a fatigued fast food junk queen if you want to beat COVID-19.

Next Up - COVID-19: GI Microbiome and COVID Susceptibility

Research

[i] Cena, Hellas, and Philip C Calder. “Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease.” Nutrients vol. 12,2 334. 27 Jan. 2020, doi:10.3390/nu12020334

[ii] Schulze, Matthias B et al. “Food based dietary patterns and chronic disease prevention.” BMJ (Clinical research ed.) vol. 361 k2396. 13 Jun. 2018, doi:10.1136/bmj.k2396

[iii] Siervo, Mario et al. “Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis.” The British journal of nutrition vol. 113,1 (2015): 1-15. doi:10.1017/S0007114514003341

[iv] Micha, Renata et al. “Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: Systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE).” PloS one vol. 12,4 e0175149. 27 Apr. 2017, doi:10.1371/journal.pone.0175149

[v] Hever, Julieanna, and Raymond J Cronise. “Plant-based nutrition for healthcare professionals: implementing diet as a primary modality in the prevention and treatment of chronic disease.” Journal of geriatric cardiology : JGC vol. 14,5 (2017): 355-368. doi:10.11909/j.issn.1671-5411.2017.05.012 

[vi] Micha, Renata et al. “Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: Systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE).” PloS one vol. 12,4 e0175149. 27 Apr. 2017, doi:10.1371/journal.pone.0175149 

[vii] Neuhouser, Marian L. “The importance of healthy dietary patterns in chronic disease prevention.” Nutrition research (New York, N.Y.) vol. 70 (2019): 3-6. doi:10.1016/j.nutres.2018.06.002 

[viii] Jayedi, Ahmad et al. “Healthy and unhealthy dietary patterns and the risk of chronic disease: an umbrella review of meta-analyses of prospective cohort studies.” The British journal of nutrition vol. 124,11 (2020): 1133-1144. doi:10.1017/S0007114520002330 

[ix] Butler, Michael J, and Ruth M Barrientos. “The impact of nutrition on COVID-19 susceptibility and long-term consequences.” Brain, behavior, and immunity vol. 87 (2020): 53-54. doi:10.1016/j.bbi.2020.04.040 

[x] Minich, D M, and P J Hanaway. “The Functional Medicine Approach to COVID-19: Nutrition and Lifestyle Practices for Strengthening Host Defense.” Integrative medicine (Encinitas, Calif.) vol. 19,Suppl 1 (2020): 54-62. 

[xi] Chiuve, Stephanie E et al. “Alternative dietary indices both strongly predict risk of chronic disease.” The Journal of nutrition vol. 142,6 (2012): 1009-18. doi:10.3945/jn.111.157222 

[xii] Tsigalou, Christina et al. “Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases. An Overview.” Biomedicines vol. 8,7 201. 8 Jul. 2020, doi:10.3390/biomedicines8070201 

[xiii] Alkerwi, Ala'a et al. “Cross-comparison of diet quality indices for predicting chronic disease risk: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study.” The British journal of nutrition vol. 113,2 (2015): 259-69. doi:10.1017/S0007114514003456 

[xiv] Estruch, Ramon. “Anti-inflammatory effects of the Mediterranean diet: the experience of the PREDIMED study.” The Proceedings of the Nutrition Society vol. 69,3 (2010): 333-40. doi:10.1017/S0029665110001539 

[xv] Soltani, Sepideh et al. “The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers: A systematic review and meta-analysis of randomized trials.” Clinical nutrition (Edinburgh, Scotland) vol. 37,2 (2018): 542-550. doi:10.1016/j.clnu.2017.02.018 

[xvi] Tsoupras, Alexandros et al. “Inflammation, not Cholesterol, Is a Cause of Chronic Disease.” Nutrients vol. 10,5 604. 12 May. 2018, doi:10.3390/nu10050604 

[xvii] Cena, Hellas, and Philip C Calder. “Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease.” Nutrients vol. 12,2 334. 27 Jan. 2020, doi:10.3390/nu12020334 

[xviii] Minich, D M, and P J Hanaway. “The Functional Medicine Approach to COVID-19: Nutrition and Lifestyle Practices for Strengthening Host Defense.” Integrative medicine (Encinitas, Calif.) vol. 19,Suppl 1 (2020): 54-62. 

[xix] Jayawardena, Ranil, and Anoop Misra. “Balanced diet is a major casualty in COVID-19.” Diabetes & metabolic syndrome vol. 14,5 (2020): 1085-1086. doi:10.1016/j.dsx.2020.07.001 

[xx] Cena, Hellas, and Philip C Calder. “Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease.” Nutrients vol. 12,2 334. 27 Jan. 2020, doi:10.3390/nu12020334