by Dr. Bob Dozor
Covid-19: risk factors for severe disease and death
“A long list is emerging from largely unadjusted analyses, with age near the top”
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1198 (Published 26 March 2020) Cite this as: BMJ 2020;368:m1198
Covid-19: risk factors for severe disease and death
- Cardiovascular Disease
- Respiratory Disease
Each of these conditions are associated with Oxidative Stress, which appears to be the main secondary trigger for severe Covid19.
The virus triggers the immune system. Modulation of the immune system regulates severity.
Oxidative stress triggers an excessive immune response called Cytokine storm, which severely inflames the lungs. This scenario is unfolding in every COVID19 patient who goes to the ICU – a distinct minority of those who fall ill. Functional Medicine doctors seek to prevent cytokine storm by reducing oxidative stress with established approaches, while pharmacologists urgently seek anti-cytokine anti-inflammatories to put out the fire.
Lifestyle Interventions, proven to increase both Lifespan and Healthspan,
may nurture resilience to COVID 19, but will likely improve your health
1. Avoid overeating
2. Eat more nuts
3. Try out turmeric
4. Eat plenty of healthy plant foods
5. Stay physically active
6. Don’t smoke
7. Moderate your alcohol intake
8. Prioritize your happiness
9. Avoid chronic stress and anxiety
10. Nurture your social circle
11. Be more conscientious
12. Drink coffee or tea
13. Develop a good sleeping pattern
Stress, Food, and Inflammation: Psychoneuroimmunology and Nutrition at the Cutting Edge
Janice K. Kiecolt-Glaser, Ph.D.
Severe-COVID19 and Aging are both the result of inflammation and cytokines – the chief strategy of the immune system. The 13 interventions together represent how to best BALANCE our immune response.
Adaptation Response and Rejuvenation
Since the basic survival capacity of any biological system depends on its homeostatic ability, biogerontologists proposed that exposing cells and organisms to mild stress should result in the adaptive or hormetic response with various biological benefits. This idea has now gathered a large body of supportive evidence showing that repetitive mild stress exposure has anti-aging effects. Exercise is a paradigm for hormesis in this respect. wikipedia
Other examples of such mild repetitive stress are calorie restriction and cold exposure.
Among the 13 “interventions” I want to emphasize:
- Calorie Restriction
- Healing through the Mind
because there is compelling evidence that these 3 are the most potent anti-aging strategies. On first blush, they are not attractive and hard to sell. Many however experience immediate and lasting benefit.
Calorie restriction such as counting calories or purchasing pre-made meals works for some people, but makes others chronically grumpy. Another strategy that may be both easier and more effective is “Intermittent Fasting.” There are different approaches to fasting. Try low intensity time restricted eating such as having an early dinner followed by a late breakfast – perhaps 14 hours; or simply skipping breakfast – maybe 18 hours. Medium intensity fasting entails skipping both breakfast and lunch – 24 hours. When you do eat, eat as much as you want! Start with one fast per week, then see how it goes. This strategy is probably not at all appropriate for someone with an eating disorder or prone to low blood sugar. Consult with your physician.
Don’t skip tea or coffee. Just minimize the calories. Personally, I feel well fasting. There is occasional hunger, but I reframe this as “cleansing my mitochondria,” actually pretty accurate, and essentially healing at a cellular level. I think there is a spiritual dimension to fasting as well. Are “Mitochlorions” mitochondria? May the force be with you!
Exercise also has potent benefits. For example, exercise can prevent Alzheimer’s disease and treat mild cognitive impairment (both of which are caused by oxidative stress). Exercise has the same effect on mitochondria as fasting. During the Pandemic, it is not prudent to employ excessive intensity which might cause temporary depression of immunity.
Healing through the Mind will be further addressed in future essays.
Homage to Plant Foods
Xenohormesis: Moderately stressed plants produce more health promoting compounds beneficial to both plants and humans: Flavonoids, Flavonols, Catechins, Resveratrol, Polyphenols, Anthocyanidin, Glucosinolate, Lycopene, etc.: Green Tea, Olives, Crucifers and other Greens, Berries (including Tomato), Artichoke, Onion and Garlic, Chocolate, Turmeric and so much more! We share a lot of our biochemistry with plants.
Spontaneous shout out:
Olive Oil and Avocados are Super-foods!
Supplements (or Food?)
Supplement recommendations are based on extrapolation from our understanding of other viral respiratory illness, because there is very limited data from COVID 19. Cytokine Storm Syndrome is seen in other Corona virus diseases like SARS and MERS, as well as in Influenza for which there is evidence of the effectiveness of these recommendations.
Many prefer food sources over supplements. I strongly prefer food sources, because supplements – being single (or a few) chemicals are more likely to unbalance our metabolism than foods, which supply complex systems of biological chemicals that have co-evolved with us. There are examples – particularly with fat soluble vitamins – of harm from high doses. Food is safe. Is Crispy Crème food?
There are 3 objectives for building COVID19 resilience:
- Stimulation of Immunity (destroy the virus)
- Modulation of Immunity (prevent Cytokine storm)
- Direct anti-viral activity
For all objectives there are FOODS and SUPPLEMENTS. Eating a plant-based diet diminishes the need to supplement. The BIG 3 supplements are:
#1 VITAMIN D stimulates immunity against respiratory viruses. Strong evidence of benefit, and wide-spread Vitamin D deficiency in temperate latitudes, and safety make it a strong recommendation. High blood Calcium levels are the main contraindication. Talk to your doctor. 800 – 5000 IU per day. Some prefer Sunshine. Some experts suggest stopping Vitamin D once illness occurs out of concern for Cytokine storm. Anthony Fauci expressed openness to Vitamin D (he stated that Tom Frieden was promoting Vitamin D)
#2 N-Acetyl-Cysteine (NAC) on the other hand is an immuno-modulator primarily intended to prevent Cytokine storm. 600 – 1800mg per day. It’s really a (highly processed) food. High doses may cause allergic or gastro-intestinal symptoms. All the studies I’m aware of regarding benefits are of NAC, but it’s likely that eating Cysteine is similar – top 10 (of many)
#1: Lean Pork Chops
#2: Beef (Skirt Steak)
#3: Lean Chicken Breast
More Whole Grains High in Cystine
-75% RDI per cup of kamut
-51% RDI per cup of whole wheat pasta
-32% RDI per cup of rice.
#8: Low-Fat Yogurt
#9: Sunflower Seeds
More Nuts and Seeds High in Cystine
-66% RDI per oz of hemp seeds
-40% RDI per oz of chia seeds
-36% RDI per oz of cashews
#10: Swiss Cheese
More Cheese High in Cystine
-43% RDI per 1/2 cup of ricotta
-30% RDI per oz of gruyere
-25% RDI per oz of gouda
#3 VITAMIN C – like NAC – an immune modulator. Eat high vitamin C foods now, but if ill consider dosing to tolerance. Dose range 1000 – 5000mg in divided doses over each day. Ascorbic Acid is less well tolerated than Buffered Ascorbic Acid which is less tolerated than Esterified Ascorbic Acid (the best). There was a study in China of high dose IV Vitamin C for COVID19, which seemed very positive. Tony Fauci also expressed optimism regarding Vitamin C. Vitamin C can cause kidney stones.
A plant-based diet will also provide:
ANTIOXIDANT substances – Green Tea, Garlic, Quercetin, ALA (alpha Lipoic acid), Blueberries, etc. seem like a good idea at any time, but Vitamin D (which is not an antioxidant), and perhaps other things (maybe Elderberry) might be best stopped if one gets sick. Apples and Nuts are rich in Quercetin – keep eating them.
MEDICINAL MUSHROOMS – any variety- Maitake, Shitake, Turkey tail, Reishi – The first two are culinary and delicious! Stimulates immunity. It has been proposed that mushrooms be stopped if one gets ill, out of concern of triggering cytokine storm.
VITAMIN E is antioxidant and immunomodulatory and best obtained from food. (Avoid d-alpha Tocopherol). Eat sunflower seeds, almonds, spinach, avocados, squash, kiwifruit, trout, shrimp, olive oil, wheat germ oil, and broccoli, and more
OMEGA 3 polyunsaturated fatty acids are immunomodulatory and can be obtained from salmon, pasture raised eggs or marine algae oil (vegetarian). Flax is questionable.
MICROBIOME – The Gut Associated Lymphoid Tissue (GALT) comprises 60% of tissue of the entire immune system. The Microbiome (bacteria, viruses, protozoans and fungi) is key, and speculatively its prudent to support it.
- prebiotic Whole Grains, beans, nuts, Oat meal. I particularly like Steel Cut Oats, and of course I have to treat my hay fever with a little local honey.
- probiotic Yogurt, Sauerkraut, Parmesan, Tibetan Butter Tea, and so many more!
BETACAROTENE – antioxidant (avoid preformed Vitamin A) – Carrots, Squash, and almost all veggies. Avoid Beta-Carotene supplements.
B-VITAMINS – in veggies big time, but a supplement won’t hurt. If Vegan you need B-12
ZINC LOZENGES seem to have a direct effect of the virus in the throat. Taking a lot of ZINC causes nausea. There are many foods, such as legumes, beans and seeds, and bivalves, rich in Zinc.