COVID-19: Optimal Takeaways for Improving Immunity and Reducing Susceptibility

Optimal Takeaways for improving immunity and reducing susceptibility to COVID-19

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

This article summarizes the Optimal Takeaways from the 23 posts that are part of the ODX COVID-19 series.

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 and 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

Diet, nutritional status, and lifestyle are modifiable risk factors for COVID-19 and its comorbidities. These factors should be highlighted in public messaging about the COVID-19 pandemic.

Biomarker clues can provide insight into the severity of COVID-19 as well as underlying nutrient insufficiencies and deficiencies.

It is imperative that assessment of key biomarkers and nutrients be part of COVID-19 evaluation, monitoring, and therapy, especially:

  • Inflammatory markers
  • Transaminase enzymes
  • LDH
  • Fibrinogen
  • WBC differential
  • Neutrophil:lymphocyte ratio
  • IL-6, IL-10
  • Albumin, prealbumin
  • Vitamin C
  • Vitamin D
  • Selenium
  • Zinc

Remember that optimal lab ranges are narrower than standard lab ranges and may give earlier clues to imbalance or deficiency.

A healthy dietary pattern modeled on the Mediterranean diet or DASH diet can help reduce the risk of chronic metabolic diseases and in turn, reduce the risk of severe COVID-19:

  • Minimum of 4 servings of fruit, 5 servings of vegetables during COVID and beyond
  • Adequate whole grains, meats, beans, dairy, protein, whey protein
  • Incorporate herbs, spices, tea, coffee daily
  • Minimum of 35 grams of fiber daily, ideally from whole foods, can supplement with psyllium
  • Include fermented foods, probiotic-containing foods
  • Adequate micronutrient intake particularly vitamins A, Bs, C, D, E, zinc, and selenium
  • Minimize or eliminate highly processed foods, added sugars and salt, excessive saturated fats, fatty processed meats
  • Targeted nutrition support should be utilized
    • A high-potency multivitamin-mineral supplement can provide a foundation with additional micronutrient supplementation as needed
  • Other factors should be considered in the fight to prevent and treat COVID-19 including
    • Sleep hygiene
    • Stress management
    • Mental health
    • Social connections
    • Environmental factors, clean air, clean water, clean food
    • Health literacy

A Traditional, Complementary and Integrative Health and Medicine Support Registry has been developed to collect longitudinal data “aiming to capture key case, treatment/supportive care, and outcome variables related to the use of traditional, complementary, and integrative health and medicine products and practices in response to the COVID-19 crisis.”[1]

Several organizations from a variety of disciplines have joined the registry and provided an integrated path for improving COVID-19 treatment and resolution.

Finally, be aware that a variety of adverse outcomes can persist even after perceived recovery from COVID-19 and can include:

  • Adverse cardiovascular outcome’s[2] [3] [4] [5]
  • Adverse psychological outcomes[6] [7] [8]
  • Adverse neurological complications[9] [10] [11] [12] [13]
  • Adverse gastrointestinal complications[14] [15] [16]
  • Adverse cutaneous complications[17]
  • Adverse effects on food supply and food security[18] [19]

Additional reading

[20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] [49] [50] [51] [52] [53] [54]

Next Up - Optimal - The Podcast: Episode 8 -Blood Biomarkers and Risk Factors for COVID-19 and its Comorbidities


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[2] Zheng, Ying-Ying et al. “COVID-19 and the cardiovascular system.” Nature reviews. Cardiology vol. 17,5 (2020): 259-260. doi:10.1038/s41569-020-0360-5 

[3] Nishiga, Masataka et al. “COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives.” Nature reviews. Cardiology vol. 17,9 (2020): 543-558. doi:10.1038/s41569-020-0413-9 

[4] Evans, Paul C et al. “Endothelial dysfunction in COVID-19: a position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science.” Cardiovascular research vol. 116,14 (2020): 2177-2184. doi:10.1093/cvr/cvaa230 

[5]Aghagoli, Ghazal et al. “Cardiac involvement in COVID-19 patients: Risk factors, predictors, and complications: A review.” Journal of cardiac surgery vol. 35,6 (2020): 1302-1305. doi:10.1111/jocs.14538 

[6] Xiong, Jiaqi et al. “Impact of COVID-19 pandemic on mental health in the general population: A systematic review.” Journal of affective disorders vol. 277 (2020): 55-64. doi:10.1016/j.jad.2020.08.001

[7] Mazza, Mario Gennaro et al. “Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors.” Brain, behavior, and immunity vol. 89 (2020): 594-600. doi:10.1016/j.bbi.2020.07.037

[8] Sher, Leo. “The impact of the COVID-19 pandemic on suicide rates.” QJM : monthly journal of the Association of Physicians vol. 113,10 (2020): 707-712. doi:10.1093/qjmed/hcaa202

[9] Paterson, Ross W et al. “The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings.” Brain : a journal of neurology vol. 143,10 (2020): 3104-3120. doi:10.1093/brain/awaa240

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[20] Kappert, Kai et al. “Assessment of serum ferritin as a biomarker in COVID-19: bystander or participant? Insights by comparison with other infectious and non-infectious diseases.” Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals, 1-36. 23 Jul. 2020, doi:10.1080/1354750X.2020.1797880

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[23] Cena, Hellas, and Marcello Chieppa. “Coronavirus Disease (COVID-19-SARS-CoV-2) and Nutrition: Is Infection in Italy Suggesting a Connection?.” Frontiers in immunology vol. 11 944. 7 May. 2020, doi:10.3389/fimmu.2020.00944

 [24] Holter, Jan C et al. “Systemic complement activation is associated with respiratory failure in COVID-19 hospitalized patients.” Proceedings of the National Academy of Sciences of the United States of America vol. 117,40 (2020): 25018-25025. doi:10.1073/pnas.2010540117

[25] Sardu, Celestino et al. “Could Anti-Hypertensive Drug Therapy Affect the Clinical Prognosis of Hypertensive Patients With COVID-19 Infection? Data From Centers of Southern Italy.” Journal of the American Heart Association vol. 9,17 (2020): e016948. doi:10.1161/JAHA.120.016948

[26] Su, Yapeng et al. “Multi-Omics Resolves a Sharp Disease-State Shift between Mild and Moderate COVID-19.” Cell vol. 183,6 (2020): 1479-1495.e20. doi:10.1016/j.cell.2020.10.037

[27] Overmyer, Katherine A et al. “Large-scale Multi-omic Analysis of COVID-19 Severity.” medRxiv : the preprint server for health sciences 2020.07.17.20156513. 19 Jul. 2020, doi:10.1101/2020.07.17.20156513. Preprint.

[28] Vaninov, Natalie. “In the eye of the COVID-19 cytokine storm.” Nature reviews. Immunology vol. 20,5 (2020): 277. doi:10.1038/s41577-020-0305-6

[29] Ragab, Dina et al. “The COVID-19 Cytokine Storm; What We Know So Far.” Frontiers in immunology vol. 11 1446. 16 Jun. 2020, doi:10.3389/fimmu.2020.01446

[30] Cazzolla, Angela P et al. “Taste and Smell Disorders in COVID-19 Patients: Role of Interleukin-6.” ACS chemical neuroscience vol. 11,17 (2020): 2774-2781. doi:10.1021/acschemneuro.0c00447

[31] Parikh, Niraj, and Devang Parikh. "Role of homoeopathy in COVID-19 Management-A clinical experience." World J. Pharm. Res 9.5 (2020): 2459.

[32] Nair, Pradeep MK. "Integrated approach of yoga and naturopathy alongside conventional care: A need of the hour healthcare strategy in the management of COVID-19 in India–An overview." Yoga Mimamsa 52.2 (2020): 70.

[33] Bousquet, Jean et al. “Is diet partly responsible for differences in COVID-19 death rates between and within countries?.” Clinical and translational allergy vol. 10 16. 27 May. 2020, doi:10.1186/s13601-020-00323-0

[34] 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

[35] Bachler, Mirjam, et al. "Impaired fibrinolysis in critically ill COVID-19 patients." British Journal of Anaesthesia (2020).

[36] Zhang, Yanhong et al. “Manifestations of blood coagulation and its relation to clinical outcomes in severe COVID-19 patients: Retrospective analysis.” International journal of laboratory hematology vol. 42,6 (2020): 766-772. doi:10.1111/ijlh.13273

[37] Wolff, Dominik et al. “Risk factors for Covid-19 severity and fatality: a structured literature review.” Infection, 1–14. 28 Aug. 2020, doi:10.1007/s15010-020-01509-1

[38] Zhang, J et al. “Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China.” Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases vol. 26,6 (2020): 767-772. doi:10.1016/j.cmi.2020.04.012

[39] Liu, Xiaofan et al. “Risk factors associated with disease severity and length of hospital stay in COVID-19 patients.” The Journal of infection vol. 81,1 (2020): e95-e97. doi:10.1016/j.jinf.2020.04.008

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[41] Fang, Lei et al. “Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?.” The Lancet. Respiratory medicine vol. 8,4 (2020): e21. doi:10.1016/S2213-2600(20)30116-8

[42] Halvatsiotis, P et al. “Demographic and clinical features of critically ill patients with COVID-19 in Greece: The burden of diabetes and obesity.” Diabetes research and clinical practice vol. 166 (2020): 108331. doi:10.1016/j.diabres.2020.108331

[43] Dietz, William, and Carlos Santos-Burgoa. “Obesity and its Implications for COVID-19 Mortality.” Obesity (Silver Spring, Md.) vol. 28,6 (2020): 1005. doi:10.1002/oby.22818

[44] Zaki, Nazar et al. “Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: A systematic review.” Diabetes & metabolic syndrome vol. 14,5 (2020): 1133-1142. doi:10.1016/j.dsx.2020.07.005

[45] Bastard, Paul et al. “Autoantibodies against type I IFNs in patients with life-threatening COVID-19.” Science (New York, N.Y.) vol. 370,6515 (2020): eabd4585. doi:10.1126/science.abd4585

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