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Coronavirus - how to boost your immune function

NUTRITION & LIFESTYLE RECOMMENDATIONS

Within a very short space of time, Coronavirus has stormed around the world, leaving many worried about the future, their health, and the health of their loved ones. There’s certainly a lot of information floating around the internet and not all of it is useful. It is important to use factual knowledge to support our actions in preventing the spread of the virus; while regularly upgraded and refined as more is learned in the face of continuing spread, there are inferences we can draw from our current pool of data which may help in the meantime. Whilst the science of coronavirus is still in its infancy, this article provides an overview of the virus and scientifically supported recommendations to boost immune function. 


WHAT IS CORONAVIRUS?

SARS-CoV-2 is the current strain of coronavirus, whilst coronavirus disease 2019 (or COVID-19) is the name of the disease people catch from this particular strain. Upon infection, symptoms can develop anywhere between 2-14 days with the three most common symptoms including fever, cough and shortness of breath, similar to that of flu. Whilst it is likely that symptoms will be mild, for some it can develop and become severe, as seen in those developing bronchitis, pneumonia and/or sepsis. Those with current conditions including diabetes, cardiovascular or respiratory disease, or hypertension may experience more severe symptoms.

Currently, prevention of the spread of coronavirus is paramount. The World Health Organisation (WHO) recommends avoiding infection by regularly and thoroughly washing your hands with soap; avoid touching your eyes, nose and mouth which may provide an entry point into the body for the virus; maintaining distance from those coughing and sneezing; and coughing or sneezing into a tissue, or your elbow crease. Whilst masks are often used to prevent contraction of coronavirus, they are not recommended for providing protection in this way. Mask use is better suited to those who are infected, wearing them to prevent the spread of the disease to others. Protection may be increased with the use of N95 or N99 mask (providing a seal is intact) which provide ~95-99% protection respectively from particulate matter in the air.  

VITAMINS AND MINERALS THAT SUPPORT THE IMMUNE SYSTEM

Those experiencing severe symptoms from coronavirus disease are considered immuno-suppressed. Therefore, increasing intake of nutrients that play a role in supporting immune function may provide protection from disease progression.

Vitamin A protects against the progression of coronavirus


Vitamin A is important for the development of the immune system and may also alleviate signs and symptoms of acute pneumonia which may develop in serious cases of coronavirus disease. (1) Increase dietary intake of vitamin A-rich foods from sweet potato and carrots (which last for an extended period of time should you require self-isolation) which can be added to soups and stews. Dark green leafy vegetables, eggs, dairy products and salmon, also provide a source of vitamin A.

Vitamin C provides antioxidant protection to cells

 

Vitamin C levels are 10 times higher in the immune-supporting white blood cell fraction of blood than in the plasma fraction, playing several roles in immune functioning. With its antioxidant properties, vitamin C provides protection to cells from the increased free radical production and subsequent oxidative stress associated with viral infections. (2) Vitamin C is also required to clear away toxic cells, protecting tissue from damage. (3) In the event of pneumonia, vitamin C levels may be depleted which, as a consequence, may reduce circulating glutathione, an important antioxidant required for modulation of the immune system. (4) 

Consider stocking up on citrus fruit and purchasing frozen fruits (berries, papaya, pineapple) which have an extended shelf-life, useful in the event of self-isolation. Other vitamin C-rich foods include peppers, kiwi and cruciferous vegetables.

We recommend: Ester-C which provides a 1000mg dose of vitamin C, proven to deliver higher amounts into cells, with faster absorption for 24-hour immune support


Vitamin D inhibits viral infections

Vitamin D is important for immune function and may play a role in the inhibition of viral infections. (5) As vitamin D is produced in the skin when exposed to UV light, it is important to supplement with vitamin D from April to October (southern hemisphere) when the UV levels are not considered strong enough to support vitamin D production in the body.

Whilst vitamin D can be consumed in the diet, guidelines on oily fish intake make it difficult to consume an adequate amount of vitamin D in the diet. Mushrooms are the only plant-based source of vitamin D but are not able to provide sufficient amounts to meet the recommended daily intake. If you have not been supplementing with vitamin D throughout winter, you may wish to seek the advice of a nutritionist who can arrange a vitamin D test and recommend an appropriate supplement dosage to increase levels.

We recommend: Pure & Essential Daily Vitamin D3 2000IU  which provideS the most biologically active form of vitamin D that is easily absorbed by the body and taken up into the bloodstream 


Zinc may provide protection from the progression of coronavirus to pneumonia

Zinc helps with regulating the immune response, with research suggesting that zinc deficiency may be a risk factor for immune deficiency and pneumonia in the elderly. (6) Whilst zinc can be consumed in the diet (grass-fed beef, lamb, sesame and pumpkin seeds, chickpeas, lentils, cashews, spinach, asparagus and mushrooms), phytates (a compound present in grains and legumes) may bind zinc, preventing its absorption. Daily supplementation with 25mg zinc, the upper limit for zinc supplementation in adults, may be beneficial to those with low zinc stores.  

Selenium may protect from sepsis

Coronavirus disease may develop to sepsis in severe cases, causing fatality. In a study on older adults (56-68 years old) in ICU with systemic inflammatory response syndrome, sepsis, severe sepsis or septic shock, daily supplementation of >500mcg selenium had a positive and statistically significant effect on mortality rate. (7) Selenium is an important antioxidant found in seafood, shellfish, poultry, tofu, eggs and brown rice. With the safe upper limit for selenium set at 300mcg, it is not recommended to exceed this without the support of a healthcare practitioner. Symptoms of excessive intake include nausea and vomiting, abdominal pain, fatigue and irritability.

We recommend: Pure & Essential Advanced Multivitamin & Minerals which contains a plant-based source of vitamins A, C & D, zinc and selenium, in their most bioavailable forms, to support immune function


INCREASE ANTIOXIDANT DEFENCES WITH BERRIES AND ONIONS

The infection of coronavirus has been described by many as a cytokine storm. Cytokines are pro-inflammatory immune cells. Whilst they are vital at the initial contraction phase, during a cytokine storm they can be over-produced, often accumulating in the lungs, leading to inflammation and a build-up of fluid. Inflammation is linked with increased oxidative stress in the body. Vitamin C, glutathione, zinc and selenium are some of the antioxidants highlighted in this article for providing protection to cells from oxidative stress during times of viral contraction. 


Quercetin, a bioflavonoid found in elderberries, cranberries, blueberries, onions and kale, has shown promise in animal studies for its antiviral properties against zika virus and ebola. (8, 9) Whilst this research does not mean that quercetin will provide protection from coronavirus, increasing your intake of these natural foods will boost your antioxidant defences as well as your intake of essential nutrients. 


SUPPORT THE HEALTH OF THE GUT WITH PROBIOTICS AND FERMENTED FOODS

Probiotics support the microbial population in the gut, with supplementation providing immune-boosting benefits and improving outcomes from respiratory infections. (10) The outcome is often strain-specific, with research showing promise for Lactobacillus and Bifidobacterium strains in providing protection to the lungs from viral infections. (10, 11) 

With an estimated 70% of immune cells living in the gut, consider reducing your consumption of foods that often cause digestive problems for you. Whilst the health of the gut can be supported in many ways (too many to cover in this article), consider feeding your gut bacteria with fermented foods, such as sauerkraut, miso and kefir, which may have beneficial effects. 

MYTH-BUSTING: GARLIC FOR CORONAVIRUS PROTECTION

Media-circulated information suggests that garlic will not provide protection from coronavirus. Whilst this is true, garlic has demonstrated antiviral properties and studies support the idea that garlic may be able to provide protection against the influenza B virus and the common cold. (12) Upping your garlic consumption, therefore, certainly won’t do any harm to your health at this point; in fact, you will gain from its beneficial effects on general health. 

FOOD SWAPS TO BOOST IMMUNE HEALTH

Whilst the above nutrients can boost the immune system, also consider ways to reduce the immune burden so that immune function isn’t depleted should infection occur. For example, hyperglycaemia can reduce immune function and increase virulence which may explain why those with diabetes are six times more likely to experience complications from influenza and why diabetes is a risk factor for mortality in coronavirus disease. (13) Consider swapping (and reducing) foods with a high glycaemic index for alternatives with a lower glycaemic index; for example, swap a slice of white toast for a wholemeal seeded bread with avocado; snack on berries rather than sweets; and an oatcake with nut butter rather than a slice of cake. Increasing your vegetable intake with meals can also reduce the glycaemic index of your meal; consider adding a side salad or an extra portion of vegetables.

STRESS RELEASE AND SLEEP TO BOOST IMMUNE HEALTH

Psychological stress may negatively alter immune function, increasing the risk for respiratory illness. (14) Whilst stress release differs for everyone, consider increasing activities that bring you joy to balance out stressful times.

Similarly, sleep deprivation can increase susceptibility to infection, with sleep providing a regulatory effect on the immune system. (15) If you are not achieving a minimum of 6 hours of sleep each night, consider ways you can support an earlier bed-time to boost immune function. 

Finally, alcohol is another immune dysregulator. (16) It may be sensible to reduce your alcohol intake at this time or consider other activities to increase social interaction beyond the close confines of the pub: a walk in nature, a yoga class or a bike ride perhaps. Engaging in exercise, including those mentioned, can have a positive effect on decreasing your perception of stress and regulating the immune system. (17, 18)

FINAL WORDS…

If you suspect coronavirus, check https://covid19.govt.nz/ for the latest advice on where to seek support. The information in this article is provided to educate readers to the multi-factorial role of the immune system, and how nutrition may play a role. Whilst so much information may seem overwhelming, especially to those caring for elderly relatives, or with underlying health concerns, making one change may benefit your immune health: going to bed earlier, swapping your afternoon treat for a handful of berries, or using the lighter nights as an opportunity to exercise outdoors. Perhaps this article will provide you with focus points that you can improve upon with the support of a nutritionist over a longer period of time, to help boost your immune system long after this coronavirus has passed and before we are faced with another viral epidemic. 

REFERENCES:

  1. Hu N1, Li QB, Zou SY (2018). ‘Effect of vitamin A as an adjuvant therapy for pneumonia in children: a Meta analysis’, Zhongguo Dang Dai Er Ke Za Zhi, 20(2):146-153.
  2. Hemilä H. (2017). ‘Vitamin C and Infections’. Nutrients, 9(4), 339. https://doi.org/10.3390/nu9040339 
  3. Carr, A. C., & Maggini, S. (2017). Vitamin C and Immune Function. Nutrients, 9(11), 1211. https://doi.org/10.3390/nu9111211 
  4. Waly, M. I., Al-Attabi, Z., & Guizani, N. (2015). Low Nourishment of Vitamin C Induces Glutathione Depletion and Oxidative Stress in Healthy Young Adults. Preventive nutrition and food science, 20(3), 198–203. https://doi.org/10.3746/pnf.2015.20.3.198 
  5. Beard, J. A., Bearden, A., & Striker, R. (2011). Vitamin D and the anti-viral state. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology, 50(3), 194–200. https://doi.org/10.1016/j.jcv.2010.12.006 
  6. Barnett, J. B., Hamer, D. H., & Meydani, S. N. (2010). Low zinc status: a new risk factor for pneumonia in the elderly?. Nutrition reviews, 68(1), 30–37. https://doi.org/10.1111/j.1753-4887.2009.00253.x 
  7. Alhazzani W, Jacobi J, Sindi A, et al. The effect of selenium therapy on mortality in patients with sepsis syndrome: a systematic review and meta-analysis of randomized controlled trials. 2013. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK133591/ 
  8. Qiu X, Kroeker A, He S, Kozak R, Audet J, Mbikay M, Chrétien M. (2016). ‘Prophylactic Efficacy of Quercetin 3-β-O-d-Glucoside against Ebola Virus Infection’, Antimicrob Agents Chemother, 60(9):5182-8. doi: 10.1128/AAC.00307-16. Print 2016 Sep. 
  9. Wong G, He S, Siragam V, Bi Y, Mbikay M, Chretien M, Qiu X (2017). ‘Antiviral activity of quercetin-3-β-O-D-glucoside against Zika virus infection’, Virol Sin, 32(6):545-547. doi: 10.1007/s12250-017-4057-9. 
  10. Lehtoranta, L., Pitkäranta, A., & Korpela, R. (2014). ‘Probiotics in respiratory virus infections’, Eur J Clin Microbiol Infect Dis, DOI 10.1007/s10096-014-2086-y 
  11. Yaqoob, P. (2014) Ageing, immunity and influenza: a role for probiotics? Proceedings of the Nutrition Society, 73 (2). pp. 309­317. ISSN 0029­6651 doi: https://doi.org/10.1017/S0029665113003777 Available at http://centaur.reading.ac.uk/68779/ 
  12. Gebreyohannes, G., & Gebreyohannes, M. (2013). ‘Medicinal values of garlic: A review’, International Journal of Medicine and Medical Sciences, 5 (9), pp. 401 - 408. 
  13. Casqueiro, J., Casqueiro, J., & Alves, C. (2012). Infections in patients with diabetes mellitus: A review of pathogenesis. Indian journal of endocrinology and metabolism, 16 Suppl 1(Suppl1), S27–S36. https://doi.org/10.4103/2230-8210.94253 
  14. Cohen, S., Tyrrell, D. A. J., & Smith, A. P. (1991). ‘Psychological Stress and Susceptibility to the Common Cold’ The New England journal of medicine, 325:606-612. DOI: 10.1056/NEJM199108293250903 
  15. Mauricio, C., deAlmeida, D., & Malheiro, A. (2016). ‘Sleep, immunity and shift workers: A review’, Sleep Science, 9, (3), pp. 164-168. https://doi.org/10.1016/j.slsci.2016.10.007 
  16. Molina, P. E., Happel, K. I., Zhang, P., Kolls, J. K., & Nelson, S. (2010). Focus on: Alcohol and the immune system. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism, 33(1-2), 97–108. 
  17. Chong, C.S., Tsunaka, M., Tsang, H.W., Chan, E.P., Cheung, W.M. (2011). ‘Effects of yoga on stress management in healthy adults: A systematic review’, Altern Ther Health Med, 17(1):32-8. 
  18. Simpson RJ, Lowder TW, Spielmann G, Bigley AB, LaVoy EC, Kunz H. (2012). ‘Exercise and the aging immune system’, Ageing Res Rev., 11(3):404-20. doi: 10.1016/j.arr.2012.03.003. Epub 2012 Mar 21. 
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