Research Blog

July 31, 2021

COVID-19: Optimal Takeaways

The COVID-19 Series: Optimal Takeaways

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 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


[1] Weeks, John. “Call to Action: Announcing the Traditional, Complementary and Integrative Health and Medicine COVID-19 Support Registry.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 26,4 (2020): 256-258. doi:10.1089/acm.2020.29083.jjw 

[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

[10] Hassanzadeh, Kambiz et al. “Considerations around the SARS-CoV-2 Spike Protein with Particular Attention to COVID-19 Brain Infection and Neurological Symptoms.” ACS chemical neuroscience vol. 11,15 (2020): 2361-2369. doi:10.1021/acschemneuro.0c00373

[11] Nikbakht, Farnaz et al. “How does the COVID-19 cause seizure and epilepsy in patients? The potential mechanisms.” Multiple sclerosis and related disorders vol. 46 (2020): 102535. doi:10.1016/j.msard.2020.102535

[12] Orooji, Yasin et al. “An Overview on SARS-CoV-2 (COVID-19) and Other Human Coronaviruses and Their Detection Capability via Amplification Assay, Chemical Sensing, Biosensing, Immunosensing, and Clinical Assays.” Nano-micro letters vol. 13,1 (2021): 18. doi:10.1007/s40820-020-00533-y

[13] Azizi, Sayed Ausim, and Saara-Anne Azizi. “Neurological injuries in COVID-19 patients: direct viral invasion or a bystander injury after infection of epithelial/endothelial cells.” Journal of neurovirology vol. 26,5 (2020): 631-641. doi:10.1007/s13365-020-00903-7

[14] Souza, Ana Carolina Remondi, et al. "Zinc, Vitamin D and Vitamin C: Perspectives for COVID-19 With a Focus on Physical Tissue Barrier Integrity." Frontiers in Nutrition 7 (2020): 295.

[15] Aguila, Enrik John T et al. “Gastrointestinal Manifestations of COVID-19: Impact on Nutrition Practices.” Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition vol. 35,5 (2020): 800-805. doi:10.1002/ncp.10554

[16] Kaafarani, Haytham M A et al. “Gastrointestinal Complications in Critically Ill Patients With COVID-19.” Annals of surgery vol. 272,2 (2020): e61-e62. doi:10.1097/SLA.0000000000004004

[17] Recalcati, S. "Cutaneous manifestations in COVID-19: a first perspective." Journal of the European Academy of Dermatology and Venereology: JEADV (2020).

[18] Laborde, David et al. “COVID-19 risks to global food security.” Science (New York, N.Y.) vol. 369,6503 (2020): 500-502. doi:10.1126/science.abc4765

[19] Naja, Farah, and Rena Hamadeh. “Nutrition amid the COVID-19 pandemic: a multi-level framework for action.” European journal of clinical nutrition vol. 74,8 (2020): 1117-1121. doi:10.1038/s41430-020-0634-3

[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

[21] Mehta, Puja et al. “COVID-19: consider cytokine storm syndromes and immunosuppression.” Lancet (London, England) vol. 395,10229 (2020): 1033-1034. doi:10.1016/S0140-6736(20)30628-0

[22] Sinha, Pratik et al. “Is a "Cytokine Storm" Relevant to COVID-19?.” JAMA internal medicine vol. 180,9 (2020): 1152-1154. doi:10.1001/jamainternmed.2020.3313

[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

[40] Jordan, Rachel E et al. “Covid-19: risk factors for severe disease and death.” BMJ (Clinical research ed.) vol. 368 m1198. 26 Mar. 2020, doi:10.1136/bmj.m1198

[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

[46] COVID, CDC. "Characteristics of Health Care Personnel with COVID-19—United States, February 12–April 9, 2020."

[47] Thibault, Ronan et al. “Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance.” Critical care (London, England) vol. 24,1 447. 19 Jul. 2020, doi:10.1186/s13054-020-03159-z

[48] Arkin, Nicole et al. “Nutrition in critically ill patients with COVID-19: Challenges and special considerations.” Clinical nutrition (Edinburgh, Scotland) vol. 39,7 (2020): 2327-2328. doi:10.1016/j.clnu.2020.05.007

[49] Laviano, Alessandro et al. “Nutrition support in the time of SARS-CoV-2 (COVID-19).” Nutrition (Burbank, Los Angeles County, Calif.) vol. 74 (2020): 110834. doi:10.1016/j.nut.2020.110834

[50] Muscogiuri, Giovanna et al. “Nutritional recommendations for CoVID-19 quarantine.” European journal of clinical nutrition vol. 74,6 (2020): 850-851. doi:10.1038/s41430-020-0635-2

[51] Serrano, Gabriel, et al. "Liposomal lactoferrin as potential preventative and cure for COVID-19." Int J Res Health Sci 8.1 (2020): 8-15.

[52] Bhapkar, Vedvati et al. “A Critical Analysis of CTRI registered AYUSH studies for COVID- 19.” Journal of Ayurveda and integrative medicine, 10.1016/j.jaim.2020.10.012. 26 Nov. 2020, doi:10.1016/j.jaim.2020.10.012

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