This article aims to capture some of the nutritional and lifestyle factors that help in the prevention or have an adjuvant contribution in the treatment of COVID-19. The ones presented here have an informative role, and do not replace, in any form, a medical treatment. I have chosen to address the healthy people at home, who can access multiple resources to remain in a physically and mentally optimal state, in these times. For those infected or those who have undergone treatment for COVID-19, nutritional intervention must be personalized and, in particular, integrated into their medical treatment scheme. For any personalized information, adapted to your situation, I recommend an online nutritional consultation. (!) This article may be changed, depending on emerging data and studies. (The romanian version: https://casaignat.ro/alimentatia-in-timpul-pandemiei-covid-19.html)

In December 2019, several cases of pneumonia of unknown origin were reported in Wuhan, Hubei, China. New technology was able to quickly detect the pathogen called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or the new coronavirus (COVID-2019). Extremely rapid human-to-human transmission has led the virus to spread from Wuhan to other regions of the Asian continent, as well as to all other continents: Europe, America, Australia, etc. The World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Interest. Today, March 28, 2020, in Romania we have the following status COVID-19: 1452 infected persons, 139 people recovered, 29 people dead, 7801 quarantined and 131 367 people are in isolation at home, under medical supervision. [1]

While multiple international research centers seek to develop a treatment / vaccine for COVID-19, there is a need to manage clinical symptoms and complications resulting from infection with the new coronavirus. Worldwide, patients are undergoing several treatment schemes similar to some conditions such as: Pneumonia, Hepatitis C, HIV, Multiple Sclerosis, while new studies continue to appear regarding the comparative analysis of the effectiveness of different medical treatment solutions..

From nutritional standpoint, the European Society for Clinical Nutrition and Metabolism (ESPEN) opens a complex aspect:

„The COVID-19 pandemics present unprecedented challenges and threats to healthcare systems around the world. The ESPEN community includes thousands of health professionals who are mainly involved in combating COVID-19, from ATI to Internal Medicine departments to General Hospitals worldwide. Saving the life of acute complications is the first goal for all of us. However, we need to remind ourselves and our nutritionist colleagues that nutritional status and nutritional care play a very relevant role in defining the short and long term outcomes of our patients. […] Even more, in difficult times of high pressure we must follow the recommendations for best practices in nutritional care to improve the results of our patients. ” [2]

Nutritional intervention can provide many benefits, depending on the health status of a person:

1. The person is healthy in home isolation,
2. The person is infected and has no other health problems,
3. The person is infected and has other health problems associated (Obesity, Diabetes, High Blood Pressure, Chronic Respiratory Diseases, Cardio-Vascular Diseases, Cancer, etc.),
4. The person was infected and is undergoing treatment for COVID-19.

For scenarios 2, 3 and 4, nutritional intervention should be integrated into a complex medical chart, adapted and personalized to the patient. In other viral problems, including HIV, nutritional intervention can improve patient status, reduce muscle fatigue and thus inability to work, may reduce the hospitalized period, increase drug tolerance (by reducing side effects), improve intestinal symptoms and, overall, improve the quality of life.

A healthy person in home isolation can take specific actions relative to the hygiene-dietary regime and to a healthy lifestyle:

1. Nutritional intake specific to home isolation conditions and high level of stress,
2. Hands’ hygiene and food handling safety measures,
3. Respiratory hygiene,
4. Sleep, physical activity and hydration,
5. Others.

1. Conditions of home isolation with high stress requires a specific nutritional intake

The immune system is constantly working to protect the body from infections, wounds and diseases. It consists of a system of organs, tissues and cells (thymus, spleen, vessels and lymph nodes, spinal cord, tonsils and others). The central nervous system can influence the activity of the immune system, through the secretion of hormones and neurons / neurotransmitters, through the activity of the hematoencephalic barrier.

The immune system can be threatened by 3 major classes:

1. Allergens, including food,
2. Microorganisms: viruses, bacteria, parasites, molds,
3. Pollutants from the environment: volatile organic compounds, heavy metals, etc.

A precarious immune system can be inflicted by a single class of pathogens listed above, or by a combination of those. During a pandemic, an uninfected person (e.i. COVID-19) while home isolation, should consider the following:

1. Eliminate food aggressors, known either via prior analysis or based on personal experience (allergens, sensitivities or intolerances). It could be sugar, fried food, alcohol more than 1-2 servings per day, barbecue as a preparation method, gluten, lactose, histamine and others. I believe that reducing lactose intake from the diet carries a significant importance, especially by avoiding the consumption of fresh milk.
2. Care for indoor air quality. Home isolation exposes us indoors to much more toxic air than we know. The US Environmental Protection Agency (EPA) points out that the level of organic pollutants in residential indoor air is 2 to 5 times higher than outdoor air, regardless of location, urban or rural. Here are a few solutions to tackle this issue:
   • The use of scientifically proven devices for the destruction of pathogens in the indoor environment: https://www.ancaignat.ro/airocide-tehnologia-unica-de-purifica-a-erului.
   • Frequent window opening for fresh air in all rooms of the house, throughout the day. The new coronavirus ”does not like oxygenated tissues” and it is essential to ventilate the rooms as often as possible, both for prevention and during the infection period (where, depending on the severity, the evolution of the disease may also involve some oxygenation devices). [3]
3. Consider optimizing intestinal flora to reduce the number of pathogenic bacteria, candidiasis or mold spores.
4. Accentuate the pathways of liver detoxification through: intake of glucosinolates (broccoli, cabbage, cauliflower, wild rocket (arugula), radishes and others) and consumption of pomegranate, blueberry, and/or turmeric for their antioxidative properties.
5. Provide ingredients that have know efficiency in chelating heavy metals (spirulina, chlorella).

The immune system needs an optimal caloric intake of 25-30 kcal / kg body-weight / day and various nutrients (macro- and micro-), such as:

I. Macro-nutrients:

• Essential fatty acids cannot be synthesized by the human body, therefore must be brought in through the diet: linseed oil (1 tablespoon / day), chia seeds, flax seeds, herring, salmon, sardines, tuna.
• Proteins; Protein-energy malnutrition (PEM) due to insufficient proteins blocks the formation of immune cells and/or formation of immune factors that protect the body from infections and diseases. Protein malnutrition is also characterized by deficiencies of vitamin A, B6, folate, vitamin E, Zinc, Copper and Selenium. In the context of strengthening the immune system, the protein intake should be higher than normal: 1.2 g protein / kg of body-weight (0.55 g protein / 1 lb of body-weight) / day {e.g. 1.2 g x 60 kg = 72 g proteins / day (0.55 g / lb x 132 lb = 72 g proteins)}. Good protein sources are: meat, fish, eggs, cheese, nuts and seeds, beans, or protein extracts (from hemp, pumpkin, peas or mixtures thereof). Another excellent source of protein are bone broth soups.

II. Micro-nutrients:

• Folate: lentils, peas, beans, leaves (spinach, kale),
• Selenium: meat (beef, pork, poultry), nuts, sunflower seeds, seafood, tuna,
• Vitamin A: of animal origin (cod oil, egg), of vegetable origin (yellow and orange fruits and vegetables (sweet potato, carrot, oranges etc),
• Vitamin B complex (B1, B2, B3, B6, B12): fish, meat, nuts and seeds,
• Vitamin C*: kiwifruit, strawberries, broccoli, kale, tomatoes, red peppers,
• Vitamin D3*: fatty fish, foods fortified with Vitamin D,
• Vitamin E: almond, avocado, sunflower oil,
• Zinc: shells, meat, beans,
• Probiotics*: Lactobacilli and Bifidobacteria,
• Bioactive compounds [4]:
  • Quercetin*: cc. 150 mg / day {can be obtained from 300 g (11 oz) onion}
  • EGCG: green tea, matcha tea {5 g powder (approx. 1 teaspoon) in 300 ml (10 fl oz) water at 85 degrees Celsius (185º F), for 3 minutes}
  • Other flavonoids: citrus fruits, especially oranges: 300 ml (10 fl oz) fresh squeezed orange juice
• Other ingredients: adaptogenic compounds from Ginseng, Rhodiola and various polysaccharides from fungi: Reischi (Ganoderma); Shiitake, Maitake [5].

*I believe that an optimal intake of Vitamin C, Vitamin D3, Probiotics and Quercetin, can be brought from foods rich in these compounds and by taking the minimum recommended dose, from supplements. For Vitamin C the recommendation is at least 400 mg / day. (Please read the ongoing study in China (https://clinicaltrials.gov/ct2/show/NCT04264533), which is monitoring the influence of intravenous Vitamin C intake in patients infected with COVID-19. Also in a statement by the Department of Infectious Diseases of Shanghai, where the cure rate is higher than other regions, an intravenous intake of Vitamin C in significant quantities is observed in the treatment schedule). Considering that we are coming off the cold season, a period during which we usually have insufficient levels of Vitamin D3 and taking into account the fact that, during home isolation, the Sun exposure (natural source of Vitamin D3) continues to be low, I recommend an additional of at least 1000 IU / day. (Low Vitamin D levels are correlated with increased risk of respiratory tract infections. [6] To read and follow Vitamin D supplementation could prevent and treat influenza, coronavirus, and pneumonia infections, article by William B. Grant, and colleagues, March 15, 2020:

https://www.preprints.org/manuscript/202003.0235/v1

A probiotic supplement should contain a variety of at least 8 species of Lactobacilli and Bifidobacteria, totaling over 1 billion strains of bacteria. Quercetin supplementation of 150 mg / day may be indicated in people who do not consume 300 g onion / day.

2. Hand hygiene and other food safety measures

According to the World Health Organization, we have 5 food safety keys:

1. Hand hygiene,
2. Food separation,
3. Thorough and optimal temperature cooking especially meat, eggs and seafood,
4. Storing and reheating food at optimum temperature,
5. Use of safe water.

Hands often carry microorganisms from one place to another, so proper hand washing is paramount. When around food, we need to wash our hands:

• Before beginning to handle food and frequently during cooking,
• Before eating,
• After going to the toilet,
• After working with raw meat,
• After changing a baby’s diaper,
• After blowing our nose,
• After playing with animals,
• After smoking.

Washing with soap for at least 20 seconds and using a dry towel (to dry our hands), preferably paper-towel. When using towels of various textile materials, it is necessary, to machine-wash/disinfect these frequently.

3. Respiratory hygiene

4. Sleep, physical activity and hydration

• Ensure adequate hours of sleep for the period dominated by anxiety, worry, uncertainty: 7 – 9 hours / night, starting at 22.00. (Special attention for children).
• Regular physical activity, of low intensity, at home, 20 – 40 minutes / day. It’s an activity that you can do with the whole family.
• The general recommendation for water intake is 25 – 30 ml (0.85 – 1 fl. oz.) water / kg-body (e.g. 30 ml (1 fl. oz.) water x 60 Kg (132 Lbs.) = 1800 ml (60 fl. oz.) water / day). During illness, water intake may need to increase, depending on the degree of dehydration of the body (fever, diarrhea, etc.). Tap water can be consumed without the risk of coronavirus infection according to the US EPA https://www.epa.gov/coronavirus/coronavirus-and-drinking-water-and-wastewater

For scenarios 2 (the person is infected, but has no other health problems), respectively 3 {the person is infected and has other associated health problems (Obesity, Diabetes, High Blood Pressure, Chronic Respiratory Diseases, Cardio-Vascular Diseases)}, Horațiu Albu MD, proposes a concise guide of practice to the specialists:

To the people with Metabolic Syndrome, Obesity and other Chronic Disseases, I recommend that you consider a specific diet and lifestyle regime, especially during this period, given the fact you have the available time to cook and follow an optimal meal schedule. It is probably the most important thing you can do to best respond, in a possible COVID-19 infection. Obesity is characterized by a state of inflammation and accompanied by a lack of essential microelements for optimal function of the immune system.

Secondary risk factors for the pandemic caused by the new coronavirus could be:

• High degree of pollution of the regional area (characteristic of Wuhan and northern Italy areas),
• Existing diseases that cause macro and micro-elemental deficiencies, implicitly a precarious immune system (e.g. protein malnutrition, deficiency of essential fatty acids and others),
• Vitamin D3 deficiency specific to cold season and/or less sun exposure,
• Hypoxia caused by low indoor air quality and sedentary lifestyle,
• High level of anxiety.

„At a global level, people describe states of fear, anger, uncertainty and especially distrust in the government, but together with these dark feelings, we begin to see images of solidarity,” The Lancet, 28 March 2020. [7]

Daily Menu highlights during home isolation, for a healthy normoponderal person

• Breakfast: Oatmeal with a handful of blueberries, pomegranate and a tablespoon of Brain Proficiency (Without it, you can add a tablespoon of flax seed, one tablespoon of hemp seed, one tablespoon chia seed)
  • A glass of fresh-sqeezed organic orange juice.
• Mid-Morning Snack: 1 matcha (or green) tea, 1 handful of cocoa beans / 2 squares of dark chocolate, 1 handful of walnuts / almonds
• Lunch: 1. Bone broth soup with root vegetables (after cooking, you may add a pinch of organic turmeric powder, 1 teaspoon of cold pressed flax oil, half a pinch of Cayenne Pepper, 1 tablespoon chopped green parsley) with 1 slice of homemade wholegrain and seeds bread. [For people who like to consume a larger variety, I recommend a second course: fish or meat with side of sweet potato, carrot and beetroot (oven cooked recommended). Use spices to taste. Optional: red onion salad.]
• Afternoon Snack: Healthy Shake: 200 ml vegetable milk, 2 tablespoons vegan protein extract, 1 tablespoon Brain Proficiency, 1 tablespoon juniper seeds, 1 tablespoon shitake powder, half of banana or avocado. Optional: you can sweeten with honey or agave syrup with inulin.
• Dinner: Steamed broccoli and cauliflower with mushrooms sautéed with 150 g. (6 oz.) (cooked weight) slow cooked meat. Add a small portion of organic wild rocket salad with cherry tomatoes and organic virgin olive oil.
• Evening Snack: a cup of basil tea.

Please take this information as an informative note, like any other article on this site. It does not replace a personalized nutrition scheme. Regarding this, we have created a Fast Nutrition Consultation service for the Immune System. For more details, visit the Services Section.

References:

1. „Informing COVID -19, Strategic Communication Group, March 28, 2020, 1 pm – MINISTRY OF INTERNAL AFFAIRS.” Https://www.Mai.Gov.Ro/, Mar 28 2020, www.mai.gov.ro/informare-covid-19-groupul-de-comunicare-strategica-28-martie-2020-ora-13-00/.
2. https://www.espen.org
3. http://shorturl.at/iozCT
4. http://shorturl.at/hTUZ6
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837746/
6. http://shorturl.at/mxBCU
7. https://doi.org/10.1016/S0140-6736(20)30686-3

Anca Ignat-Sâncrăian