This year (2020) will go down in history as the year the deadly SARS-CoV-2 virus that causes Covid-19 changed our lives.
Even now, we are still surrounded by this new enemy lurking within our midst that has turned out to be more sinister and aggressive than anticipated.
Despite many countries having decreased their case numbers after locking down their communities, we are now seeing this infection re-emerging around the world as countries relax their lockdown measures and open their borders.
While reintroducing the strict restrictions of the earlier movement control order (MCO) in Malaysia might help to protect us from the virus, the effect on our economy and the livelihoods of many Malaysians would be quite severe.
Therefore, the burden of preventing transmission of SARS-CoV-2 is very much ours to bear as individuals and responsible citizens, especially now as our country is being threatened with the possibility of a second wave of Covid-19 cases.
When it comes to eradicating this virus, vaccination is the ideal path.
News of many potential vaccines in development is no doubt comforting and encouraging, but each potential vaccine must first pass through a series of clinical trials and tests to ensure that it is safe enough for human use.
This will take time.
Right now, the best way to protect ourselves is to not get infected at all and this is where good hand hygiene, physical distancing and face mask use play a crucial role.
And if we do somehow still get infected with Covid-19, we need to be healthy and fit enough to survive the infection.
Knowing our vulnerabilities
As a doctor who practises preventive medicine, let me bring you some functional medicine perspectives on how to keep healthy in these trying times.
Functional medicine stems from the West, although it shares similar ideologies with Eastern medicine.
It is an approach to health that emphasises supporting our physiology and biochemistry.
As such, it works well in disease prevention and health maintenance.
Viruses are known to be very tricky germs as they can mutate and replicate very fast.
We know that healthy people who are free of other diseases, do better than those with other (co-morbid) medical conditions when it comes to Covid-19 (and indeed, many other illnesses).
Knowing the silent vulnerabilities in our health will enable us to be better prepared to do what is best for ourselves by understanding our risk factors, lifestyle habits, food choices and personal health history.
Asthmatics for example, suffer from inflammatory airway disease; hence the chances of developing severe airway inflammation and subsequent obstruction with breathing complications will be more pronounced if they succumb to the SARS-CoV-2 virus.
Similarly, for diabetics with uncontrolled sugar levels, there will be a state of increased oxidative stress and viral replication will be more pronounced.
Among all the physiological processes at play, the three main components that need to be managed so that we can live and thrive in this current pandemic are:
- Reducing oxidative stress
- Balancing inflammatory pathways, and
- Harmonising our internal microbiome.
Reducing oxidative stress
Oxidative stress is an imbalance between the free radicals and antioxidants in our body.
Free radicals are oxygen-containing molecules with an uneven number of electrons.
This uneven number allows them to easily react with other molecules as they are always seeking to balance out their number of electrons.
Oxidation occurs when the fee radical gains an extra electron from another molecule.
This happens daily in a small manner when we are regularly exposed to small amounts of germs in our environment, which is actually beneficial to help build a healthy immune system.
When the virus is new and aggressive however, the human body has the potential to create a “cytokine storm” – an overreaction of the body’s immune system where pronounced acute oxidative stress causes the immune system to become harmful to the body.
To alleviate this oxidative stress situation through diet and foods, we need to:
Including antioxidant-rich, nutrient-dense foods in our daily diet, such as fruits and vegetables, may be a helpful measure for reducing oxidative activity.
Vitamins or phytonutrients that are water-soluble (e.g. vitamin C) or fat-soluble (e.g. carotenoids, tocopherols, tocotrienols and vitamin D), are natural antioxidants.
An analysis of thousands of food samples revealed that herbs and spices, nuts and seeds, dark chocolate, vegetables, and green tea contain some of the highest
levels of antioxidants.
The manner in which food is prepared and cooked, such as chargrilling and deep frying); the use of food or taste enhancers like MSG (monosodium glutamate); the consumption of processed food; and the use of preservatives to increase the shelf life of foods, all lead to a condition that can create oxidative compounds referred to as advanced glycation end products (AGEs).
These products provoke an exaggerated inflammatory response, which can cause some individuals to develop exaggerated responses to healing that result in health complications.
The lifestyle factors that contribute to oxidative stress is the price we pay for living in this commercially-centred society.
Factors like inadequate sleep, lack of a nutritious diet, obesity, too little or too much exercise, stressful work and home environments, constipation, smoking and many others all contribute towards chronic oxidative stress.
However, oxidative stress can be reduced if our lifestyle habits and attitude towards life are changed for the better.
Balancing inflammatory pathways
Inflammation is actually a protective response of cells to the dangers of pathogens, infection or tissue damage.
It involves the coordinated communication of different immune cells and blood vessels through an intricate cascade of molecular signals.
While inflammation is required in the initial stages of an immune reaction to infection, prolonged release of inflammatory mediators can cause system-wide problems.
Numerous studies have suggested that an inflammatory dietary pattern is one that is high in sugary and diet soft drinks, refined grains, and processed meat, but low in cruciferous and yellow vegetables.
Functional medicine clinicians suggest refraining from an Americanised diet, and instead shift towards a balanced dietary pattern resembling the traditional plant-based Asian diet, and well-studied Okinawan and Mediterranean diets.
These diets help maintain the balance of inflammation through the omega-6 to omega-3 fatty acid ratio.
Reducing or omitting foods that negatively impact the inflammatory cascade, such as those containing added sugars, salt or trans fats, as well as those that have a high glycaemic index or excessive amounts of saturated fat, would be helpful in lessening the overall inflammatory burden.
At the same time, do consume plant-based foods like fruits, vegetables and legumes, which contain phytonutrients and polyphenols that help to counter and reduce inflammation.
Harmonising our internal microbiome
The gastrointestinal tract contributes the majority of immune system activity.
Therefore, it is essential to keep it nourished with the necessary nutrients for a healthy gut microbiome (bacteria population).
Eating more fermented foods such as yoghurt, kefir, kimchi, miso and sauerkraut, may provide microorganisms and secondary metabolites that help with immune response, and even reduce the incidence and duration of respiratory infections.
Fermentation by-products have been shown to reduce the growth of pathogens in the oral and upper digestive tract.
For example, consuming kefir, which contains six lactic acid bacteria strains, resulted in an increase in natural killer cell (a type of white blood cell) activity.
Short-chain fatty acids (SCFA) are produced when fibre is fermented in the colon.
They act as a source of energy for the cells lining the colon.
They also have good immune-modulating activities, including improving gut barrier function and innate immunity.
High-fibre diets are therefore important for our immunity as they increase the level of SCFA in our bodies.
Healthy individuals are recommended to take approximately 25-35g of fibre daily.
Foods that benefit our gut bacteria include:
- Artichokes, garlic, onions and asparagus, which contain the dietary fibre inulin.
- Fruits and vegetables, which contain the plant carbohydrate fructo-oligosaccharide.
- Grains, barley, legumes and beans that have been cooked and cooled, which contain resistant starch that acts similarly to fibre.
- Apples, apricots and carrots, which contain the prebiotic pectin.
- Wheat bran fibre, which contains the dietary fibre arabinoxylan.
- Cheese, butter and cow’s milk, which contain the SCFA butyrate.
As stated by obesity researchers Dr Mark L. Heiman and Dr Frank L. Greenway in their 2016 paper published in the journal Molecular Metabolism: “The more diverse the diet, the more diverse the microbiome and the more adaptable it will be to perturbations.”
In conclusion, if the above three physiological processes are well supported and dealt with regularly in a proper manner, viral replication and multiplication will be minimal.
The acute reactive inflammation that is meant to be part of the healing process will also be self-contained and not evolve into the dangerous and harmful cytokine storm.
We would have created a passively aggressive defence strategy that has higher potential to promote effective healing without turning on the human host, i.e. you and me.
Dr Krishnaveni Kanason is a general practitioner (GP) and functional medicine practitioner. For more information, email email@example.com. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.