The day after my 40th birthday, my whole world shut down. COVID-19 hit the United States. Recommended lockdowns started to spread across the country. We pulled the kids out of school and everyone stayed home. For months. Some people are still at home.
At first, we were scared. We didn’t know what was going to hit us. The messages were confusing. Numbers kept increasing. New York was getting hit the hardest, while the rest of us watched.
But, eventually, things started to slow down. States started to open. We started to have breathing room again to look at this in a rational way.
For me, as a registered dietitian, my curiosity lies in understanding WHY this happened and what can be done to “slow the spread”. So, I went to the smartest cookies I know, my colleagues, and asked them questions about the connection between Covid-19, lifestyle, and nutrition.
These recommendations are not meant to be utilized in lieu of other public health recommendations, like social distancing or mask wearing, although I do have many opinions about those, I am not an expert.
My colleagues and I are experts in nutrition, so I am going to stick with that. Many of my colleagues have dug deep into this topic, so I thought I would put together a summary of what we do know about Covid-19, health, and nutrition. At the end, I share my own recommendations based on what I have learned from researching and writing this article.
Preventative Measures with Nutrition and Lifestyle
You CANNOT prevent Covid-19 or any viral infection with diet or lifestyle changes.
But, you can do a lot to help your body naturally fight off any pathogen it comes across. These are all simple lifestyle changes you can start working on today.
It doesn’t have to be complicated. My colleagues recommended simple changes like:
- A healthy diet (more on that later)
- Maintaining a healthy weight
- Getting adequate sleep
- Managing stress
- Getting outdoors in the sunlight
- Moving your body daily
- Supporting the health of your gut
- Alcohol in moderation
- Not smoking
- Spend time in community (even if its virtual)
Lisa Andrews, MEd, RD, LD recommends “keep a water bottle filled. Try not to turn to coffee or alcohol despite the temptation to overindulge to deal with stress and anxiety.”
Lisa also emphasizes the importance of physical activity for immunity and stress relief. She says “I advise my clients to try to maintain the good habits they had pre-COVID. If they were exercising at a gym before and it’s closed, get outside and walk”.
Basically, normal healthy habits of sleep, good nutrition, exercise, and stress management all help immunity. All of these tips may not seem groundbreaking, but are the foundation of living a healthy lifestyle which can be beneficial towards managing any illness.
Food Safety and Covid-19
I remember at the beginning of the pandemic, there was a lot of fear over food packaging or contracting Covid-19 by touching something at the grocery store. I hope that this concern has died down at this point.
Covid-19 is an airborne virus. The CDC website clearly states that there is NO EVIDENCE of spread from surfaces, even though no one is quite sure how long the virus can live on a surface.
That being said, there is no reason to use bleach or sanitizing wipes on your food or food packaging (or Amazon boxes). This can harm you, especially if you apply bleach or sanitizers directly to food. Instead once you return from the grocery store, simply wash your hands once you get home and after handling the packaging.
For around the house you can use normal household cleaners in high touch areas. You don’t need to go crazy with this. This EPA chart shows you how long it takes for common household products to kill the virus.
Over sanitizing may actually be harmful to your health. Antibacterial products can kill off beneficial bacteria and may contribute to antibiotic resistance. An overly sterile environment may negatively impact the microbiome, or the healthy bacteria that live in our bodies, and suppress immunity.
Additionally, the FDA has recalled many hand sanitizing products over the last few months due to dangerous ingredients.
Basically, wash your hands when coming and going out of your home, after using the bathroom, or before eating. Wipe down high touch surfaces once or twice a week. Stop thinking everything is contaminated.
Covid-19 and Obesity
Even before Covid-19 showed up in the US, I started hearing about how bad it could be here, in terms of illness and deaths because of our obesity crisis. Tina Marinaccio, MS, RD says “Our country has the highest number of avoidable deaths compared to peer nations due to our obesity epidemic. Younger people who require ventilation often have NAFLD (Non-alcoholic fatty liver disease), sleep apnea, or metabolic syndrome due to excess weight.”
Over 40% of US adults are obese, with even more falling into the overweight category. It is well-documented that obesity increases inflammation. Complications from Covid-19 seem to be related to the virus’s ability to increase inflammation to a dangerous level, which we will discuss in more detail a bit later.
If most people in the US are struggling with obesity, and in turn inflammation, this puts us at significant risk of complications from this disease. Patients with inflammation-related comorbidities such as diabetes or hypertension, have a significantly increased risk of serious complications or death from Covid-19. A study in JAMA found that of 5700 hospitalized patients in New York City, 88% had two or more chronic health conditions.
For some reason, talking about obesity and Covid risk has become just as controversial in the nutrition community, as taking hydroxychloroquine.
People in the United States are metabolically sick. Circular arguments about whether it’s caused by their excessive weight, unhealthy diets, or sedentary lifestyle are completely futile. We need to provide a solution to obesity and metabolic disease.
As nutrition professionals it is our duty to help people be healthier. Bottom line. We all know that healthy lifestyle practices without significant weight loss can help, but I still believe we need to help patients lose weight if that is their desire.
That being said, now is not the time for fad diets or trying to lose weight as quickly as possible. Bonnie Nasar, RDN says “getting healthy is not an overnight transformation. We need to break it down into small pieces. Any improvement of nutritional status is better than no improvement at all. We cannot eliminate a person’s diabetes in a day, but sustainable changes over time will help to reach this goal…any change is a step in the right direction towards better health.”
If you are overweight, start small. Set achievable goals of going for a daily walk, eating more fruits and vegetables, or drinking more water. If you need help with achieving a healthier lifestyle, I have many amazing colleagues that can help.
Dietary Recommendations If You Get Covid-19
Complications from Covid-19 tend to arise once system-wide inflammation sets in. You may have heard of this referred to as the cytokine storm. This is when certain inflammatory markers get out of control, which damage critical organs. Once this begins, most patients take a turn for the worst. This is when they end up with multiple organ failure and in the ICU on a vent. Few patients are able to come back from this stage.
But, there is a lot that can be done to slow the inflammatory process and possibly prevent the most devastating side effects of this disease. Ideally, reducing inflammation and strengthening immunity starts before you even get sick. A first step is to implement the lifestyle changes mentioned above which can decrease inflammation.
Follow an Anti-Inflammatory Diet
An anti-inflammatory diet can also help. Tina recommends a diet with plenty of fruits, vegetables, lean proteins, and healthy fats. The focus of the diet should be colorful fruits and veggies, as most plant pigments have anti-inflammatory properties.
For more information on anti-inflammatory diets:
- Check out my book “The Anti-Inflammatory Diet One Pot Cookbook” (affiliate link)
- Tina’s article: What to eat on an anti-inflammatory diet?
- Bonnie’s immune support meal plan.
Stay Hydrated and Well-Nourished
A fellow colleague had Covid-19 earlier this year and she was willing to share her personal experience with the illness with me. Her primary recommendation is to stay well hydrated and eat. She experienced a significant lack of appetite, which she believes ended up hindering her healing.
Aim to drink at least 8-10 cups of water per day. Warm herbal tea or other warm beverages can be soothing as well.
If you lose your appetite or sense of smell, you still need to try to eat. Malnutrition can make any illness worse, including Covid-19. Even a vegetable soup can help get something into your system. The purpose is to not allow yourself to get too weak.
The use of dietary supplements is controversial. Covid-19 is such a new illness that research on it is changing all the time. Bonnie very smartly said this “A lot of people read one news article and run to buy supplements or specific foods. What I wish people understood is this: one study means nothing until it is reproduced. The process of science is meticulous, and slow. This can be frustrating…the media is rushing to give the information to us, but they sometimes jump the gun. One study is not enough to radicalize interventions.”
As more time passes, the more we learn about this virus. We will have more treatments and protocols available. But, people are dying NOW and if anything can help, I want to share the information I do have.
In the meantime, I encourage you to take this information and continue to research it as it is changing daily. But here is what seems to be true right now:
- Vitamin D
Vitamin D plays a role in immunity. Many of us suffer from deficiency in this vitamin because we spend too much time indoors (vitamin D is made from sun exposure) and food is generally a poor source. Obesity also increases the risk of vitamin D deficiency.
There seems to be an emerging connection between vitamin D deficiency and Covid-19 mortality. Amanda Izquierdo, RD commented on this research. She said “while some emerging evidence suggests that low vitamin D levels can lead to higher mortality rates for those with COVID-19, at this time, the research is reflecting correlation not causation.”
Amanda is definitely right about the research being new and based on this we cannot determine causation. But, I believe that vitamin D deficiency sets us up for poor immune function overall, even prior to Covid-19.
Ideally, before taking a vitamin D supplement, you should have your levels checked by your doctor. If your level is below 50 mmoL/L you want to consider taking a vitamin D supplement. Depending on the severity of your deficiency, your doctor may give you a prescription for a megadose of vitamin D. Do not take high doses of vitamin D if it has not been recommended by your doctor.
If you are unable to get your vitamin D level checked, due to wide-spread deficiency, lack of time spent outdoors, and flu season approaching, I recommend most people take a supplement anyway. (Always check with your doctor first). One study found that 1000-1500 IU per day was required to maintain adequate vitamin D levels, this is the amount I recommend.
Zinc plays a critical role in immune health. Even a mild zinc deficiency can suppress the immune system. Those at risk for zinc deficiency, happen to also be the same group that is at risk for severe complications from Covid-19: the elderly, those with inflammatory conditions, or people taking zinc-depleting medications, like ACE-inhibitors or diuretics. (Here is a list of conditions that increase risk).
My colleague Jena S. Griffith, RD, IHC the Nutrition Director of the Culpeper Wellness Foundation has taken an in-depth look at the connection between Covid-19 and zinc deficiency. She states “Viruses like SARS-CoV-2 are highly dependent upon the metabolism of the host cell. Ample evidence suggests zinc not only prevents viral entry into the cell, but directly reduces its virulence once inside. Early on in the pandemic it seemed apparent that zinc deficiency and symptoms of Covid-19 were not only intersectional but identical.”
Jena explains that in order for zinc to enter the cell, it needs a transport molecule, called an ionophore. A 2010 study found that treatment with zinc in combination with an ionophore was effective at inhibiting the replication of coronaviruses and other viruses..
The controversial drug Hydroxychloroquine is a zinc ionophore. Since I am not a medical doctor, I am going to stay in my lane with this topic and not discuss the research around this medication. But, there are many naturally occurring zinc ionophores, such as quercetin and epigallocatechin-gallate (EGCG) that can be effective as an alternative.
Zinc should not be taken as a regular supplement, as it may lead to deficiencies in other minerals, like copper. It also has an upper limit that should not be exceeded for an extended period of time. Foods high in zinc include: oysters, pumpkin seeds, meat, and legumes.
Quercetin is a naturally occurring flavonoid found in apples and other vegetables. It has anti-inflammatory and anti-viral properties. Not only is quercetin a zinc ionophore, a 2020 paper in Frontiers in Immunology found that it may be an effective therapy for the prevention and treatment of Covid-19 due its synergistic relationship with vitamin C and the immune system. Quercetin has been found to inhibit replication of respiratory viruses, which may apply to Covid-19..
- Vitamin C
Vitamin C is an essential antioxidant for helping modulate immune response and reduce inflammation. A 2020 review in PharmaNutrition found that there is evidence to support the use of high dose IV vitamin C as a therapy for acute respiratory distress syndrome (ARDS), one of the advanced conditions associated with Covid-19. Vitamin C also helps recycle quercetin, which has its own possible benefits for reducing disease severity.
Although I don’t recommend high dose IV vitamin C for prophylaxis, eating more vitamin C-rich foods is always a good idea. Fruits and vegetables are your best bet. Fill your diet with citrus, strawberries, bell peppers, and tomatoes. These foods are loaded with antioxidants, including vitamin C, that support your health and immune system.
Other dietary supplements under investigation that play a role in immune regulation: n-acetyl cysteine, glutathione, echinacea, melatonin, astragalus, Boswellia, turmeric, and resveratrol. Many of these play a role in managing inflammation as well.
Covid-19 Nutrition Recommendations
Based on my research, if you do get Covid-19, here is what I recommend. Be sure you stock up what you need now, so you have everything available if it happens. What I am recommending is NOT a cure or a guarantee of any kind, but based on current available research, it may be able to give your body a fighting chance of beating this virus. You should always listen to your doctor for the best treatment protocol for you.
At the onset of symptoms of suspected Covid-19:
- Focus on hydration
- Stay home and rest
- Wash your hands regularly
- Try to limit contact with other non-infected family members
- Limit sugar intake
- Focus on anti-inflammatory foods (fruits, vegetables, fish), but don’t overly stress about your diet. Eating SOMETHING is most important.
- Take these supplements x 7 days at the first onset of symptoms:
- 500 mg quercetin 2x per day
- 1000 mg Vitamin C
- 2000 IU Vitamin D
- 50 mg zinc (methionine, glycine, gluconate, sulfate, picolinate, or acetate)
Consult your doctor if you have any difficulty breathing or have worsening symptoms. This information is not meant to substitute medical advice.
In Summary: Covid-19 and Nutrition
I spent an extensive amount of time on this article because I wanted to get this information out there to empower you. You can do something besides hiding in your house to slow the spread of Covid-19. I actually feel the hiding, anxiety, and complete panic has been more damaging our long term health and immunity than any virus could be.
I want to share hope and solutions around this virus. I don’t want to play the blame game over who’s fault it is. The virus is here. Our focus should be on helping each other heal. I believe nutrition heals.
If this information is widely available, we can keep people healthy. We do not need to suffer. My colleague Cheryl said it best “As a country, we are very good at going to heroic measures to save a person’s life when they come to the ER with a heart attack or stroke. Why are we not doing the same thing when it comes to preventative medicine?”
Together, and with less divisiveness, we can stop this. We have the tools. We just need to have the courage to stand up and focus on our health.
Note: I would like to thank all my amazing colleagues Jena S. Griffith, Cheryl Mussatto, Bonnie Nasar, Tina Marinaccio, Amanda Izquierdo, and Lisa Andrews for their amazing support and generosity in writing this article.