Optimal - The Blog

August 17, 2021

COVID-19: Reducing Your Risk and Co-Morbidities

What You Need to Know: Reduce Your Risk of COVID and Co-Morbidities

Beth Ellen DiLuglio, MS, RDN, LDN

COVID-19 is a highly contagious viral infection that may be asymptomatic or may present with severe or even fatal sequelae. Severity of the disease appears to be associated with fixed risk factors such as advanced age, immunosuppression, malignancy, darker skin, and end-stage diseases including lung, liver, and kidney disease. [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]

It is also associated with conditions and modifiable risk factors that may become chronic but can be addressed with lifestyle changes and nutrition intervention.[12]

Modifiable risk factors for severe COVID-19 include

  • Blood glucose dysregulation
  • Cardiovascular disease
  • Diabetes, type 2
  • Excess alcohol intake
  • Exposure to pollution and toxins
  • Hypertension
  • Inflammation
  • Lack of sunlight exposure
  • Nutrient insufficiencies
  • Obesity
  • Oxidative stress
  • Sedentary lifestyle
  • Smoking
  • Unhealthy Western-style diet

Avoid an unhealthy dietary pattern containing an excess of: [13] [14]

  • Animal fat
  • Commercial snack & convenience foods
  • Concentrated sweets
  • Diet soft drinks
  • Fast foods
  • Fried foods
  • Highly processed foods
  • Processed meats
  • Red meat
  • Refined grains
  • Sodium, added salt
  • Sugar, sugar-sweetened beverages
  • Trans-fats
  • And LACK of fresh fruits, vegetables, whole unprocessed foods

Adopt a healthy dietary pattern with an abundance of: [15] [16] [17] [18] [19] [20] [21]

  • Dairy, low-fat, fermented
  • Healthy fats, omega-3s
  • Herbs, spices
  • Purified water
  • Fruits, 4 servings per day (fresh, include citrus, berries, etc.)
  • Lean protein
  • Legumes, beans
  • Nuts, seeds
  • Plant-based foods
  • Seafood, fish
  • Vegetables, 5 servings per day (fresh, include leafy greens, cruciferous, etc.)
  • Whole, unprocessed foods
  • Whole grains
  • Vitamins: A, Bs, C, D, E
  • Minerals: copper, iron, magnesium, selenium, zinc
  • Phytonutrients: flavonoids, polyphenols
  • Tea, coffee

Lifestyle factors that promote optimal health and help reduce the risk of infectious disease and comorbidities include:

  • An active lifestyle with regular exercise
  • Goals and achievements
  • Health awareness and literacy
  • Mental health checkups
  • Recreation and “down time”
  • Restful sleep 7-9 hours per night
  • Self-care
  • Social connections and interactions
  • Stress management

The bottom line of what you need to know about reducing the risk of COVID-19 and its comorbidities is:

  • Adopt a healthy plant-based diet abundant in micronutrients, phytonutrients, antioxidants, fiber, and purified water.
  • Avoid or minimize highly processed and fast foods.
  • Incorporate regular physical activity and structured exercise into your day.
  • Manage stress… anticipate its arrival and plan for its departure.
  • Sleep well for as long as you need to, most need 7-9 hours.
  • Plan achievable, fulfilling goals.
  • Social interactions are important too!


[1] Williamson, Elizabeth J et al. “Factors associated with COVID-19-related death using OpenSAFELY.” Nature vol. 584,7821 (2020): 430-436. doi:10.1038/s41586-020-2521-4

[2] Ejaz, Hasan et al. “COVID-19 and comorbidities: Deleterious impact on infected patients.” Journal of infection and public health vol. 13,12 (2020): 1833-1839. doi:10.1016/j.jiph.2020.07.014

[3] Gallo Marin, Benjamin et al. “Predictors of COVID-19 severity: A literature review.” Reviews in medical virology, e2146. 30 Jul. 2020, doi:10.1002/rmv.2146

[4] Richardson, David P, and Julie A Lovegrove. “Nutritional status of micronutrients as a possible and modifiable risk factor for COVID-19: a UK perspective.” The British journal of nutrition, 1-7. 20 Aug. 2020, doi:10.1017/S000711452000330X

[5] Wu, X et al. “Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis.” Science advances vol. 6,45 eabd4049. 4 Nov. 2020, doi:10.1126/sciadv.abd4049

[6] Nandy, Kunal et al. “Coronavirus disease (COVID-19): A systematic review and meta-analysis to evaluate the impact of various comorbidities on serious events.” Diabetes & metabolic syndrome vol. 14,5 (2020): 1017-1025. doi:10.1016/j.dsx.2020.06.064

[7] Albitar, Orwa et al. “Risk factors for mortality among COVID-19 patients.” Diabetes research and clinical practice vol. 166 (2020): 108293. doi:10.1016/j.diabres.2020.108293

[8] Zheng, Zhaohai et al. “Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis.” The Journal of infection vol. 81,2 (2020): e16-e25. doi:10.1016/j.jinf.2020.04.021

[9] Hernández-Galdamez, Diego Rolando et al. “Increased Risk of Hospitalization and Death in Patients with COVID-19 and Pre-existing Noncommunicable Diseases and Modifiable Risk Factors in Mexico.” Archives of medical research vol. 51,7 (2020): 683-689. doi:10.1016/j.arcmed.2020.07.003

[10] Matsushita, Kunihiro et al. “The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis.” Global heart vol. 15,1 64. 22 Sep. 2020, doi:10.5334/gh.814

[11] Baradaran, Ashkan et al. “Prevalence of Comorbidities in COVID-19 Patients: A Systematic Review and Meta-Analysis.” The archives of bone and joint surgery vol. 8,Suppl 1 (2020): 247-255. doi:10.22038/abjs.2020.47754.2346

[12] 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.

[13] Schulze, Matthias B et al. “Dietary pattern, inflammation, and incidence of type 2 diabetes in women.” The American journal of clinical nutrition vol. 82,3 (2005): 675-84; quiz 714-5. doi:10.1093/ajcn.82.3.675

[14] Belanger, Matthew J et al. “Covid-19 and Disparities in Nutrition and Obesity.” The New England journal of medicine vol. 383,11 (2020): e69. doi:10.1056/NEJMp2021264

[15] 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

[16] 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

[17] 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

[18] 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

[19] 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

[20] 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

[21] 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

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