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Social distancing and regular handwashing are the most effective and proven methods to reduce risk and spread of the coronavirus disease (COVID-19). However, along with general questions on how to safely shop for and prepare food (addressed here), many are wondering about the more specific role of diet and nutrition during this pandemic. To understand more about the link between nutrition and immunity, and existing evidence on nutrient status, supplementation, and infection, we spoke with Dr. Wafaie FawziDr. Walter Willett, and PhD student, Dr. Ibraheem Abioye. As more information becomes available on this topic, we will check back with our experts to provide additional updates. (Last update: 4.1.20)


Can you briefly summarize the relationship between nutrition and immunity? 

We have known for a long time that nutrition is intricately linked to immunity and to the risk and severity of infections. Poorly nourished individuals are at a greater risk of various bacterial, viral, and other infections. Conversely, chronic or severe infections lead to nutritional disorders or worsen the nutritional status of affected people. Therefore, it is imperative for all of us to pay attention to our diet and nutritional status during the ongoing COVID-19 pandemic. Furthermore, the clinical course of COVID-19 disease tends to be more severe among older individuals and among people with chronic conditions, such as diabetes, hypertension and cancer that are partly related to nutrition. [1] Although data are not yet available, co-infections, such as HIV/AIDS, may also be associated with more severe outcomes, and optimal nutrition plays an important role in maintaining health among people with such infections.

Indeed, consuming good quality diets is always desirable, and this is particularly important during the COVID-19 pandemic. A healthy diet, as depicted by the Healthy Eating Plate, emphasizes fruits, vegetables, whole grains, legumes, and nuts, moderate consumption of fish, dairy foods, and poultry, and limited intake of red and processed meat, refined carbohydrates, and sugar. Added fats should be primarily liquid oils such as olive, canola, or soybean oil.  Such a diet will provide appropriate amounts of healthy macronutrients and essential minerals and vitamins. Eating high-quality sources of proteinfat, and carbohydrate can help maintain a healthy weight and good metabolic state; this is not a time for highly restrictive, crash diets. If someone does develop a COVID-19 infection, eating enough of these healthy calories to prevent unintended weight loss is important. Adequate amounts of minerals and vitamins provided by a healthy diet helps to ensure sufficient numbers of immune cells and antibodies, which are important as the body mounts a response to infections.

Although we have no data regarding nutritional factors in relation to risk and severity of COVID-19, what are some examples of existing evidence on nutrition and infection that would be important to consider?

There have been many studies evaluating intakes of specific nutrients in relation to other infections. To give a few examples:

  • Zinc is a component of many enzymes and transcription factors in cells all over the body, and inadequate zinc levels limit the individual’s ability to mount an adequate immune response to infections. [2] Multiple meta-analyses and pooled analyses of randomized controlled trials (RCTs) have shown that oral zinc supplementation reduces the incidence rate of acute respiratory infections by 35%, shortens the duration of flu-like symptoms by approximately 2 days, and improves the rate of recovery. [3,4] The studies were conducted in the US as well as in multiple low- and middle-income countries such as India, South Africa, and Peru. The dose of zinc in these studies ranged from 20 mg/week to 92 mg/day. Dose does not appear to be the main driver of the effectiveness of zinc supplementation.
  • Vitamin C is a cofactor for many enzymes. It enhances the function of many enzymes all over the body by keeping their metal ions in the reduced form. It also acts as an antioxidant, limiting inflammation and tissue damage associated with immune responses. [5] RCTs evaluating the effectiveness of vitamin C have been conducted among soldiers, young boys, and older people in the US, the Soviet Union, the UK, and Japan. In these studies, vitamin C supplementation was shown to significantly reduce the incidence of respiratory tract infections. [6] The effectiveness of vitamin C has also been studied among hospitalized patients in the US, Egypt, and Iran, admitted for a wide variety of conditions including severe sepsis, postoperative complications, burns, lung contusions, and cardiac conditions. [7] Vitamin C was shown to reduce the duration of stay in the intensive care unit and need for mechanical ventilation among these patients. [8] The dose of vitamin C varied from 1-3 g/day, and dose does not appear to be the main driver of effectiveness. Doses of vitamin C above 2 g/day should be avoided outside of medical care.
  • Evidence from several clinical trials and pooled studies show that vitamin D supplementation lowers the odds of developing acute respiratory tract infections (most of which are assumed to be due to viruses) by 12% to 75%. [9-12] These studies included both the seasonal and pandemic flu caused by H1N1 virus in 2009. The beneficial effect of supplementation was seen in patients across all ages, and individuals with pre-existing chronic illnesses. [13] Among those who were infected, flu symptoms were fewer and recovery was earlier if they had received doses of vitamin D greater than 1000 IU. [14] The benefits were relatively greater in individuals with vitamin D deficiency than in those who had adequate levels of vitamin D.
  • Older adults are most often deficient in these helpful micronutrients, and thus can derive the greatest benefit from supplementation. [15,16]

You mention that optimal nutrition plays an important role in maintaining health among people with infections such as HIV/AIDS. Can you expand on that a bit more?

Many acute respiratory tract infections tend to be more severe in people living with HIV/AIDS and other immune deficiencies, [17] and surveillance efforts for COVID-19 targeting these populations are important. Nutrition also has an important role in this category of people. First, HIV infection and malnutrition tend to co-exist. As the disease becomes severe, many people living with HIV tend to be undernourished. Some HIV drugs also lead to metabolic disease. Second, among patients with HIV infection, poor nutritional status and micronutrient deficiencies worsen HIV disease and increase the risk of treatment failure and death. Before the advent of antiretroviral therapy, studies demonstrated that people living with HIV with higher quality diets and better nutritional status tended to live longer and had fewer complications. They were less likely to be anemic and had higher CD4 cell  counts (counts of white blood cells that fight infection). Randomized controlled trials and large cohort studies in Africa and Asia have also shown that the use of multivitamins leads to fewer deaths and slows down disease progression considerably. [18-20] The findings from these studies were consistent whether the HIV-infected patients were receiving antiretroviral therapy or not. In the US, optimal intake of vitamins and minerals was similarly associated with reduced HIV disease progression and mortality. [21] Therefore, good quality diet and multivitamin supplementation are likely to be helpful in reducing the risk of COVID-19 infection among people with HIV and similar diseases.

Is there a role for nutritional supplements in the COVID-19 Pandemic?

Dietary surveys in the US and elsewhere show that most people are consuming diets that do not meet national guidelines—often because of availability or cost—and such diets may not provide optimal quantities of essential vitamins and minerals. Currently, the ongoing COVID-19 pandemic is likely to put many more individuals at risk of food insecurity and make consuming a healthy diet even more difficult. This becomes increasingly likely if the infection risk-mitigation strategies do not include approaches to ensure essential supplies are effectively distributed and accessible, or if the pandemic affects productivity of the agricultural sector.

Although we are not aware of good data on the effects of nutritional supplements on risk or severity of COVID-19, existing evidence indicates that supplements of several nutrients can reduce risk or severity of some viral infections, particularly among people with inadequate dietary sources. Therefore, prudence suggests that inadequate intakes of essential minerals and vitamins be avoided at this time, and supplements can help fill some gaps. Some key points:

  • Taking a standard (RDA) multivitamin/multimineral supplement as a nutritional safety net is reasonable. These supplements are a relatively inexpensive (should cost less than $40 USD for a six month supply) and convenient way to replenish and maintain micronutrient stores.
  • Maintaining adequate levels of vitamin D is particularly important. Vitamin D is normally produced in our skin when exposed to sunlight, and in the late winter and spring blood levels of vitamin D tend to be low because of reduced sun exposure. Staying indoors will further reduce blood levels. Although we do not have evidence at this time whether vitamin D supplements will reduce the severity of COVID-19, they might, especially among people with low levels.  Because the cost of blood testing is usually more than the cost of supplements (and not appropriate while our health care system is seriously stressed), and because there are other benefits from maintaining adequate vitamin D, taking supplemental vitamin D would be reasonable for most people to consider.
    • Many of the commonly available multivitamin/multimineral supplements do contain 1000 or 2000 IU of vitamin D, which is a good target.
    • People with darker skin (who tend to have lower blood levels because melanin in the skin blocks ultraviolet light) may need more vitamin D; up to 4000 IU per day is considered safe.
    • If vitamin D supplements are not available, try to take advantage of sunlight, which is now starting to become intense enough to produce vitamin D. Expose as much skin as possible in the middle of the day and begin for short periods to avoid burns.  With light skin, 15 minutes can produce a large amount and with dark skin 3 or 4 times longer will be needed.
  • At this time, megadose supplements (many times the recommended dietary allowance, or RDA) do not appear justified, and these can sometimes be harmful.
  • Avoid any supplements promoting wild health claims. At this time, the US Food and Drug Administration has been monitoring and warning companies offering fraudulent products claiming to prevent, diagnose, treat, or cure COVID-19.
  • Nutritional supplements should be not be considered to be substitutes for a good diet, because no supplements contain all the benefits provided by healthy foods.

Source: https://www.hsph.harvard.edu/nutritionsource/2020/04/01/ask-the-expert-the-role-of-diet-and-nutritional-supplements-during-covid-19/

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We all know that life is filled with ups and downs, but when you’re in the midst of a particularly hard time, it can be hard to picture how you’ll ever get out of it. You can only do so much to change your circumstances, and with most situations, there will be factors you can’t control or change. This can feel frustrating and scary, but rather than continue to let your stress and anxiety about a situation worsen, you can incorporate a number of strategies that can help you get through hard times. 

Talk therapy is always the best solution during times of uncertainty or sadness, but it’s not always accessible to everyone. And even if you do speak to a professional, there are still a number of habits you can incorporate that can help keep you afloat during a stressful period. Here are some routines that experts recommend to their patients during times of sadness and uncertainty: 

1. Practice acceptance.

“It is essential to have skills to navigate challenges, as learning these will enable you to develop a sense of confidence in your ability to cope,” psychologist Nicole Issa, Psy.D., tells mbg.

The first thing you can do is accept the current circumstances along with your thoughts and emotions that come along with it. “Nonacceptance leads to suffering, as you will only perpetuate a struggle if you are in denial or battling reality,” says Issa. “Once you choose to practice radical acceptance, you open yourself up to the possibility of less suffering and making appropriate changes.”Article continues below

2. Be mindful.

To help you accept your thoughts and feelings, as well as work through them, you’ll want to stay mindful. “Mindfulness is the practice of being present and accepting what’s arising without judgment,” therapist and meditation teacher Joree Rose, M.A., LMFT, tells mbg. It might sound counterintuitive, but this practice can help you avoid some stress and emotional pain.

“Bring your attention to the present moment and focus on observing and describing different sensations,” says Issa. “This will help you to feel more grounded.” 

3. Incorporate intentional breathing. 

You can also cultivate mindfulness by practicing deep breathing. “Taking deep breaths will calm your emotional brain and calm your body,” says Rose. “The breath will be able to quiet down the heart rate, calm the sensations in the body, as well as bring your mind’s attention back to the here and now.”

4. Keep moving.

Most people tend to think of exercise as solely beneficial for their physical health, but movement can work wonders for your mind as well. “Moving your body will ground you mentally and boost your immune system,” internist Erika Schwartz, M.D., tells mbg. Research has found that three to five 45-minute workouts a week can help reduce your number of “poor mental health days” by 40%, with poor mental health defined in the study as stress, depression, and emotional concerns. 

5. Set news and social media limits.

It’s tempting to want to check in on what’s going on everywhere all the time, but too much screen time can make stress and anxiety worse. “Limit news and social media to 10 to 20 minutes per day,” says Schwartz. “Instead, turn on healing music, read a book, watch comedies and romantic movies, or watch a documentary. And maybe you just limit watching TV, phone, or tablets to two hours a day maximum. Watch how much better you’ll feel.”

6. Stay connected.

Even if you can’t physically be with someone, stay connected with a few friends or family members. We need social connection, so try FaceTiming or texting. “Reach out to people you haven’t talked to in a while,” says Rose. Connecting with someone and talking about how you feel may sound like the last thing you want to do, but research shows that social support can help combat stress and depression.

7. Maintain a routine.

It can seem difficult to keep going about your everyday life when you’re feeling out of sorts, but make an attempt to stick to a routine. “Without a routine, we can slip into feeling like we have no purpose, and with no purpose, we can easily slip into depression,” says Rose. “We need to maintain normalcy for our mental stability, and when life does return to normal, we want that transition to be smooth.”

Everyone will have their own habits that help them get through a rough patch, but these expert-backed strategies are little things you can do to help build up your mental endurance. Find what works for you, and stick to it.

Source: https://www.mindbodygreen.com/0-17809/7-tips-for-dealing-with-life-if-you-cant-afford-a-therapist.html?mbg_mcid=777:5e8a94e8102e51451e489b54:ot:5c22b3f39799ec3cc6aecb97:1&mbg_hash=57103be3843e0e1cb6615f5efa797221&utm_source=mbg&utm_medium=email&utm_campaign=daily_v2_20200406

It’s not *only* so you stop touching your face so much.

Wearing Contacts During Coronavirus: Eye Doctors Suggest Glasses ...

The American Academy of Ophthalmology (AAO) recently revealed that conjunctivitis—aka pink eye, an irritation of the eye that can cause redness, swelling, and discharge—may be a rare, early symptom of COVID-19. Now, the AAO is issuing a number of coronavirus eye safety tips—and one includes opting out of wearing contact lenses for the time being.

In a recent statement, ophthalmologist Sonal Tuli, MD, a spokesperson for the AAO, advised that those who wear contact lenses should stick to wearing their glasses for a while. “Consider wearing glasses more often, especially if you tend to touch your eyes a lot when your contacts are in,” said Dr. Tuli. “Substituting glasses for lenses can decrease irritation and force you to pause before touching your face.”

The AAO also points out another benefit of wearing glasses over contacts during the coronavirus pandemic: They may add a layer of protection. “Corrective lenses or sunglasses can shield your eyes from infected respiratory droplets,” said Dr. Tuli—but he added that it’s not 100% protective. “The virus can still reach your eyes from the exposed sides, tops, and bottoms of your glasses.” If you’re caring for a sick person, the AAO said, “safety goggles may offer a stronger defense.”

This information comes on the heels of a statement that, while rare, COVID-19 can cause conjunctivitis in a small number of patients—about 1 to 3%, per the AAO. The virus can also spread through infected eye fluids, or viral particles that enter through your eyes.

“We have been learning that eye symptoms can be involved in COVID-19 infection, and ocular secretions may be a means of transmission,” Vicente Diaz MD, a Yale Medicine ophthalmologist tells Health.  “In those patients with eye symptoms, it is impossible to say whether infection may have started in the eyes. Face touching, eye rubbing, or exposure of the ocular surface to droplets containing the virus are all theoretical ways this can happen,” adds Dr. Diaz.

In addition to suggesting wearing glasses over contacts, the AAO also urged everyone to avoid touching their face or rubbing their eyes. “If you feel an urge to itch or rube your eye or even to adjust your glasses, use a tissue instead of your fingers,” said Dr. Tuli. He also added that, because dry eyes can lead to rubbing, it may be wise to add moisturizing drops to your routine, if you’re prone to dry, itchy eyes. Those with seasonal allergies are also at a higher risk of hand or eye touching.

If you absolutely must touch your face or eyes—or you continue to use contact lenses—handwashing is key: “Hand hygiene is more important than ever, especially for those that continue to use contact lenses,” Kevin Lee, MD, eye physician & surgeon from the Golden Gate Eye Associates within the Pacific Vision Eye Institute in San Francisco, tells Health. That means thoroughly washing hands with soap and running water for at least 20 seconds, and then properly drying them with a clean towel. 

Other preventive measures surrounding coronavirus and eye health include not sharing eye drops or cosmetics right now, says Dr. Lee. “It’s possible for the tip of the eye dropper or mascara to be contaminated by coming into contact with the ocular secretions of someone who is COVID-positive,” he says.

As always, if you are experiencing symptoms commonly associated with coronavirus—fever, dry cough, fatigue, shortness of breath—self-isolate and call your doctor to see if you qualify for a coronavirus test. Depending on your doctor’s input, recommendations, and possible test results, you may need to further self-isolate and treat symptoms at home; and if your symptoms or conditions worsen, contact your medical provider again. Additionally, once symptoms clear, it’s best to wash your pillow covers, face towels, hand towels, and throw out any makeup or disposable contacts used while symptomatic.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it’s possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

Source: https://www.health.com/condition/infectious-diseases/coronavirus/wearing-contacts-during-coronavirus

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