As of June 2021, the outbreak of coronavirus disease (COVID-19) has spread to 6 continents, resulting in more than 3.8 million deaths worldwide.1 Recent studies suggest that in addition to direct viral damage, uncontrolled inflammation caused by excessive inflammatory cytokine activation contributes to disease severity in COVID-19. This pathogenic inflammation, also known as cytokine storm, has been seen previously with other severe coronaviruses, including SARS-CoV.

In his article, "Could Dietary Factors Reduce COVID-19 Mortality Rates? Moderating the Inflammatory State"2 published in the Journal of Alternative and Complementary Medicine, Arnold R. Eiser, MD, MACP, discusses the important role of nutrition in determining an individual's inflammatory status. Furthermore, he suggests that an anti-inflammatory diet has the potential to moderate preinfection inflammatory status that could have an effect on the severity of illness if one should contract COVID-19.

INTERVIEW

The following represents a summary of my interview with Dr Arnold Eiser regarding the important role of nutrition as it relates to COVID-19 infections:

Ross: Your commentary in the Journal of Alternative and Complementary Medicine suggests that diet may be a factor in the severity of COVID-19 infections. Would you explain how the foods we eat could have an impact on COVID-19 manifestations?

Eisler: The most severe manifestations of COVID-19 are a sign of cytokine storm or overdrive. Tissue damage occurs when proinflammatory cytokines initiate destructive processes. Diet is a significant determinant of one's baseline cytokine status, probably the most significant. Certain foods lower inflammation: extra virgin olive oil, leafy green vegetables, fatty fish, nuts, berries, cherries, and some other fruits. On the other hand, the American diet is rife with foodstuffs that promote inflammation: sugar and refined carbohydrates including bread, pastries, also fried foods, processed meats, red meats, lard, and other saturated fats.

Ross: What is the timing with regard to an anti-inflammatory diet and cytokine activation?

Eiser: Experimental studies on this topic clearly show that if a diet is consumed to exert a beneficial effect, it must be started at least several days before the infection is initiated or it will not have an impact.

Ross: Research has shown a direct connection between inflammation and the foods that we eat; if this is established by studies, why is it not being widely recommended for COVID-19?

Eiser: While there is experimental evidence supporting this concept, it is not a proven fact in humans, although there are several lines of indirect evidence in humans as well as laboratory subjects supporting it. Methodical research in this area is definitely needed but is fairly unlikely to garner the necessary research funding.

Ross: How do certain foods reduce inflammation?

Eiser: Certain types of chemicals contained in such foods including polyphenols and flavonoids downregulate or reduce the release of inflammatory cytokines such as interleukin-6 or interleukin-18. Phytoestrogens that are found in tofu and other soy products also appear to do so.

Ross: It has clearly been established that excess consumption of sugar and refined carbohydrates creates an inflammatory response.3 Are there other foods that increase inflammation?

Eiser: Lipid peroxidation appears to be a fundamental process in the proinflammatory process of foods. Fried foods promote lipid peroxidation. The products of lipid peroxidation are cytotoxic and promote cardiovascular disease and neurodegeneration.

Ross: How did you come to write this article?

Eiser: I have been writing and researching information related to neurotoxicity in today's lax environmental regulation for a book and several journal articles when I realized this process of cytokine activation likely has relevance for COVID-19 manifestations as well.

Ross: What can one learn from this?

Eiser: Diet is vitally important to protecting one's health. There literally is no health without a proper diet. Obviously, other components of health are crucial too, including proper exercise, air and water free of toxicants, social supports, meaningful community, work, and spiritual life. One can also observe that a holistic approach to health is really common sense and essential.

Ross: Have you gotten the COVID-19 vaccine as well?

Eiser: Absolutely. The dietary changes I am recommending do not take the place of immunization or other public health measures. No component of medical care has achieved more for humanity than immunization. We need science in our lives and in our work.

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