CORONAVIRUS PANDEMIC: DIET AND NUTRITION Battling the Deadly Cytokine Storm – The Latest Research!
CORONAVIRUS PANDEMIC: DIET AND NUTRITION
Battling the Deadly Cytokine Storm – The Latest Research!
By Steve Blechman
On April 20, my article entitled: Coronavirus Pandemic: Health Crisis War – Fight it Now! (musculardevelopment.com) reported on a very dangerous and deadly cause of the coronavirus called the cytokine storm. The cytokine storm is a severely dangerous hyper-immune reaction to infection of the coronavirus in the lungs, in which the immune system overproduces inflammatory cytokines which can damage lungs and cause inflammation of the air sacs of the lung, which can inhibit oxygen in the body – causing pneumonia, respiratory failure and the requirement of a ventilator. Recent research has shown that the cytokine storm can also cause inflammation and cell damage to the heart, liver, brain, kidneys, intestines, as well as cause abnormal blood clots, which are causing lower body amputations and sudden cardiac thrombosis and death.
What Are Cytokines, And Why Can They Be So Deadly?
In those people infected with the COVID-19 virus, the coronavirus particles enter your body through your nose, mouth or eyes, into your lungs. The immune system recognizes the virus and sends immune-signaling molecules called cytokines such as interleukin-6 (IL-6) and tumor necrosis factor (TNF). Normally these cytokines play a beneficial role by activating our innate immune response and certain white blood cells called macrophages, neutrophils and natural killer cells that destroy and kill certain dangerous pathogens, bacteria and viruses. These white blood cells are like “killer, phagocytic Pac-Men” that release reactive oxygen species (ROS) free radicals and kill these bacteria and viruses. At the same time, these ROS free radical species damage normal tissues and cause inflammation and cell death. So these white blood cells in fact are a two-edged sword – they kill dangerous viruses and bacteria or they can go haywire, causing severe inflammation cell damage and organ failure!
At this time, there are no FDA-approved drugs to treat or cure COVID-19. Several drugs are now being investigated to help battle the cytokine storm. The malaria drug hydroxychloroquine that has also been approved for lupus and autoimmune disease has most recently been reported to calm down the hyperimmune response and might be helpful in those that are mildly ill from the coronavirus. Moving forward, we need to do better designed, more controlled, double-blind randomized clinical trials that prove safety and efficacy with hydroxychloroquine with the results published in reputable peer-reviewed journals. We can’t depend on just case reports on their own with hydroxychloroquine, or with Z-Pak combo. Several anti-inflammatory drugs are approved for treating rheumatoid arthritis such as tocilizumab (Actemra), which I mentioned in my last article developed by Genentech and sold by Roche Holding AG. Also, Regeneron Pharmaceuticals Inc. and Sanofi (Kevzara) are also testing these rheumatoid arthritis drugs that inhibit interleukin-6, which can affect inflammation. As I said in my last article, a late-stage U.S. study with Kevzara including 400 patients will be available at the end of early May and soon after published in a reputable peer-reviewed journal. Also, a study with Pfizer’s rheumatoid arthritis drug Xeljanz is doing a clinical trial on coronavirus patients, and expected to be published this summer. Side effects of some of these anti-inflammatory drugs approved for rheumatoid arthritis include upper respiratory infections, hypertension, hepatotoxicity, and immune risk of certain cancer by downregulating the immune system.
We already know people over age 65 are at the highest risk of dying from the coronavirus. People who are overweight and obese and have pre-existing diseases such as diabetes, heart disease, and hypertension are also at greater risk. A healthy diet and lifestyle changes such as following the Mediterranean diet along with exercise has been shown in the scientific research to safely prevent and lower the risk of obesity, metabolic syndrome, diabetes, hypertension and cardiovascular disease.
It was reported this past Wednesday, April 22, 2020 in the Journal of the American Medical Association (JAMA) that “in a case series that included 5,700 patients hospitalized with COVID-19 in New York City, the most common comorbidities were hypertension, obesity and diabetes.” Obesity and being overweight has been shown to increase the incidents of hypertension and diabetes. Recent research and new studies say that obesity may be one of the most predictors of severe COVID-19 illness in the United States, which has one of the highest obesity rates in the world. Also, the study reported that more than 94% of patients hospitalized had other pre-existing ailments. High blood pressure was the most prevalent ailment. Renowned infectious disease expert Dr. Anthony Fauci most recently recommended further research on anti-hypertensive drugs such as ACE inhibitors and ACE blockers. Research is already underway to see if the blood pressure-lowering drugs may be a contributing factor! In animals, these blood pressure-lowering drugs have been shown to enhance the expression of the ACE2 receptor and may increase the severity of the disease. Warning: If you are on an ACE inhibitor or ACE blocker for hypertension, you should not stop taking them unless recommended by a physician or cardiologist.
The obesity epidemic is real and upon us – about 4 in 10 Americans are obese! Like I said earlier, obesity or being overweight increases metabolic syndrome such as hypertension, diabetes and cardiovascular disease, which can increase the risk of death in patients with coronavirus. Research has shown that obesity can exacerbate the cytokine storm! Infectious diseases experts have said that the coronavirus is going to be around for a while and most likely reoccur in the fall/winter along with the flu.
We are most likely not going to have a vaccine for the next 12-18 months or later! We need to take charge now and change our lifestyle to eat healthier and control our weight. We need to eat healthier foods and exercise more to control our weight and lower the risk of severe illness and the ravages of the cytokine storm!
The Mediterranean diet an anti-inflammatory diet has great potential to naturally tame the uncontrolled hyperimmune response from the cytokine storm. It is also the healthiest diet, based on the latest scientific research. The Mediterranean diet was the best diet for 2018 and it is still the best diet for 2020 and beyond, based on the latest scientific research! In 2018, U.S. News & World Report ranked the Mediterranean diet as the best overall diet for healthy eating, tied with the DASH diet. The Mediterranean diet was also ranked number one for the easiest diet to follow; best diet for diabetes; best heart-healthy diet and best plant-based diet too. U.S. News & World Report (January 2nd, 2019) selected the Mediterranean diet as the best overall diet and healthiest diet for 2019. It was also rated the best diet for preventing heart disease and diabetes. The keto diet was ranked 38 for overall diets! It was tied for first place for fast weight loss but not best in the long run because of the high amount of unhealthy saturated fats, which can raise the risk of cardiovascular disease. These results were based on a panel of 23 experts, and 41 diets based on the scientific literature. The expert panel consisted of the country’s top nutrition experts and physicians specializing in weight loss, diabetes, and cardiovascular disease.
Several studies have shown that a low-carb, ketogenic Mediterranean diet is a healthier alternative to low-carb, ketogenic high-saturated fat diets for weight loss. It has the favorable effect on non-atherogenic lipid profiles lowering LDL cholesterol, triglycerides, lowering blood pressure and inflammation and improving fasting blood glucose levels, and reduction in waist circumference (Nutrition Journal, October 26, 2008; Nutrition Journal, October 12, 2011; Nutrients, December 18, 2013). A recent study showed that the Mediterranean style diet may also lower stroke risk in women, which was reported by the American Heart Association’s journal Stroke in October 2018. Another recent Harvard study published in the Journal of the American Medical Association (JAMA) on December 7, 2018, found a 25% reduction in cardiovascular risk on the Mediterranean diet! Finally, a recent study published in the International Journal of Cardiology on November 27, 2018 reported that the cholesterol-lowering statin drugs worked best when combined with a Mediterranean diet compared to statin drugs alone! Lowering inflammation and LDL (bad cholesterol) seems to be the likely synergistic benefit of combining the Mediterranean diet and statin drugs in people with cardiovascular disease and lowering mortality risk.
People who strictly follow the Mediterranean diet tend to have a lower body mass index (BMI), which is a measure of the proportion of weight to height and waist circumference – according to a large population study led by Simona Bertoli from the Nutritional Research Center in Milan, Italy. The Mediterranean diet is high in fish, seafood, antioxidant-rich vegetables, red wine and berries rich in polyphenols, beans, lentils, nuts, legumes and extra-virgin olive oil (EVOO) that are rich in healthy monounsaturated and polyunsaturated fats and low in saturated fats. Extra-virgin olive oil contains oleic acid, a monounsaturated fatty acid, and a polyphenol called oleuropein that can increase brown fat thermogenesis. Brown fat is a special kind of fat cell that generates heat and helps regulate bodyweight and energy expenditure. The body has two forms of fat – white fat and brown fat. Brown fat burns calories. The more brown fat you have, the more calories you burn. The capability of harnessing one’s one brown fat for fat burning is revolutionary! The ability to get lean by producing extra brown fat and enhancing and activating existing brown fat represents a promising way to burn fat. Several landmark discoveries and approaches to this are being explored at major research centers and universities worldwide with great excitement. Brown fat research is a hot topic today! Studies indicate that the Mediterranean diet promotes metabolic health, boosts fat loss, prevents obesity and may increase longevity. (Clinical Nutrition, 2016; J of Nut Sci and Vitaminology, 2008; J Nutritional Biochemistry, 2017)
As I mentioned in my last article, a breakthrough, long-term diet study was recently published in the American Heart Association journal Circulation on measuring body fat. This diet study used magnetic resonance imaging (MRI) technology for the first time, measuring changes in body and organ fat during 18 months on a Mediterranean/low-carb diet, with and without moderate physical exercise. MRI is a diagnostic technique that produces computerized images of organs and internal body tissues using a magnetic field and radio waves. This is the best approach to date for measuring body fat, compared to weighing people as a result of diet and exercise. The scale, skinfold calipers or underwater weighing aren’t giving you the whole picture.
The Mediterranean low-carb diet was significantly superior to a low-fat diet in decreasing fat storage, including visceral (deep abdominal) liver and heart fat. High visceral fat has been shown to increase metabolic syndrome, inflammation, cardiovascular disease and diabetes. Losing deep subcutaneous visceral fat, as well as haptic (liver) fat, was associated with improved insulin sensitivity and improved lipid profile. In a groundbreaking, two-year dietary intervention study published in the New England Journal of Medicine, researchers found that the Mediterranean and low-carb diet was beneficial for weight loss. It appears to be just as safe, metabolically healthier and more effective for weight loss/fat loss compared to a low-fat diet. Consumption of monounsaturated fats (extra-virgin olive oil and nuts) is thought to improve insulin sensitivity, which may explain the favorable effect on blood glucose and insulin levels. Research has shown that nut consumption can enhance weight loss and weight gain (N Engl J Med, 2008)
The Mediterranean diet contains healthy fats from monounsaturated fats and low in bad fats. Twenty-five years ago, nutritionists discouraged nut consumption because of their high fat content. Mountains of evidence show that nuts are a healthy food that reduces the risk of cardiovascular disease, cancer and all-cause mortality. A meta-analysis that combined the results of 20 studies involving more than 819,000 people, led by Dr. Dagfinn Aune from the Imperial College London, found that consuming 28 grams of nuts per day was linked to a reduced risk of coronary heart disease (29%), stroke (70%), cardiovascular disease (21%), total cancer risk (15%) and all-cause mortality (22%). Adding nut consumption to your daily diet can have a marked improvement on your health and prevention of disease. (BMC Medicine, 2016)
A study published in the European Journal of Nutrition cites nuts like walnuts, peanuts, pistachios and almonds help to increase weight loss and prevent obesity. Nuts are low in carbohydrates, are rich in fiber and are a good addition to the low-carb Mediterranean diet. (European Journal of Nutrition, 2017)
Fish consumption, rich in omega-3 fats that are found in oily fish like wild salmon, for instance, is a healthy component of the Mediterranean diet. The omega-3 fats in fish have been shown to activate brown fat thermogenesis and reduce waist circumference (Adipocyte, 2018). Numerous studies have demonstrated that fish oil lowers body fat and prevents fat accumulation in white adipose tissue (WAT) compared to other dietary oils. Fish oil intake can induce mitochondrial uncoupling protein (UCP1) expression in brown and beige adipocytes and thereby attenuate fat accumulation (Scientific Reports, 2015)
Regular salmon consumption is part of a heart-healthy diet. Ocean and wild fish are preferable over farmed fish. They are richer in omega-3 polyunsaturated fatty acids. For example, farmed tilapia is not a healthy fish because it is very low in omega-3 fatty acids and rich in arachidonic acid, a polyunsaturated fatty acid that can increase inflammation and is linked to a higher risk of cardiovascular disease, cancer, metabolic syndrome and insulin resistance. Other rich food sources of arachidonic acid are found in beef, poultry, pork, butter, cream and egg yolks. Grass-fed beef is lower in arachidonic acid. Arachidonic acid is high in meat and poultry because of the feeding of corn to cattle, hogs and hens.
The research has shown that the saturated fatty acids that also raise LDL (bad) cholesterol are found in coconut oil (lauric, myristic, palmitic acid). On a chart where coconut oil is listed in the Circulation study, it has about 90% saturated fats. Butter has about 64% saturated fat and beef about 40% saturated fat. Not only is coconut oil the richest source of saturated fat but also a rich source of saturated fatty acids (lauric, myristic and palmitic acids) that raise LDL cholesterol. Palmitic acid is the worst saturated fat when it comes to cardiovascular health and raising LDL cholesterol. Research has shown that palmitic acid is the most atherogenic fatty acid and also enhances inflammation. Animal fats such as meat and butter are rich sources of palmitic acids. Also, a study in the American Journal of Clinical Nutrition found that increasing dietary palmitic acid decreases fat oxidation (fat burning) and daily energy expenditure (thermogenesis). The study found that oleic acid, the most abundant fatty acid in olive oil, had the opposite effect – increasing fat oxidation, energy expenditure and thermogenesis. The study said that “increases in dietary palmitic acid may increase the risk of obesity and insulin resistance.” Proliferator-activated receptor coactivator 1a (PGC-1a) is a critical regulator of brown fat (BAT) activity in response to environmental stimuli such as cold temperature and diet (Environmental Epigenetics, 2017). Palmitic acid inhibits PGC-1a while oleic acid increases it; therefore, palmitic acid is not desirable if you want to increase brown fat activity. Monounsaturated fats are preferred along with omega-3 fats from fish if you want to increase brown fat activity, thermogenesis and fat loss. Not all saturated fats have a negative effect on LDL (bad) cholesterol. For instance, stearic acid, a saturated fat found in cocoa butter, does not raise LDL cholesterol, according to recent research.
In conclusion, this article is a scientific review on how a healthy, proper diet and nutrition lifestyle such as the anti-inflammatory Mediterranean diet may help protect and battle the deadly cytokine storm during the coronavirus pandemic. Even though cases of the coronavirus are going down, we cannot take our foot off of the pedal! Eating healthy and improving our metabolic health and exercising more can help control our weight and improve our metabolic health, which is essential. More testing (which includes for diagnosis and antibodies, as well as possible tracing of those that have been exposed), effective antivirals, and treatments such as monoclonal antibodies, anti-inflammatory drugs and Cytosorbents, a new blood-purifying device that may be used to treat the deadly cytokine storm. Also, therapeutics such as convalescent plasma therapy and randomized controlled trials need to continue so we can establish safety and efficacy until an effective vaccine is made available. We can win the war with the coronavirus with the help of all of our wonderful health care workers and leading research centers. We can recover and kill the virus. Can’t is not in my vocabulary – only can is!
Sources:
1. Centers for Disease Control and Prevention (CDC)
2. National Institutes of Health (NIH)
3. Johns Hopkins Center for Health Security
4. Food & Drug Administration (FDA)
5. Journal of American Medical Association (JAMA)
6. New England Journal of Medicine (NEJM)
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59. Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association Frank M. Sacks, MD, FAHA, Chair, Alice H. Lichtenstein, DSc, FAHA, Jason H.Y. Wu, PhD, MSc, Lawrence J. Appel, MD, MPH, FAHA, Mark A. Creager, MD, FAHA, Penny M. Kris-Etherton, PhD, RD, FAHA, Michael Miller, MD, FAHA, Eric B. Rimm, ScD, FAHA, Lawrence L. Rudel, PhD, FAHA, Jennifer G. Robinson, MD, MPH, FAHA, Vice Chair, Neil J. Stone, MD, FAHA, and Linda V. Van Horn, PhD, RD, FAHA, Vice Chair On behalf of the American Heart Association.
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