The Importance of Nutrition for Diabetics During the COVID-19 Pandemic

By Hamza Alvi, Director of Food Hub at STL Food Angels

Nowadays, it feels impossible to tune into the news without a mention of COVID-19, the infectious disease caused by the virus SARS-CoV-2. This microscopic virus has crept into every corner of our lives and infected our lives and infected our bodies, our society, and our lifestyles. But SARS-CoV-2 does not affect everyone equally. COVID-19 poses a higher threat for the elderly, especially if they also are victims of an underlying chronic disease, such as lung disease, cancer, cardiovascular disease, and diabetes [1]. Most of the people infected with COVID-19 show mild flu-like symptoms, or some don’t develop symptoms at all. While others rapidly deteriorate with viral pneumonia. The novel coronavirus can cause detrimental effects for seniors (65+ years old), including higher rates of hospitalizations, increased ICU admissions, and deaths [2]. On April 18, 2020, CDC reported 3,310 deaths seen in people aged 65 and up. Comparatively, only 15 deaths were seen in a person aged below 24 [3]. 

While the disease has impacted the elderly, it also created undeniable challenges for the type 2 diabetic population. Type 2 Diabetes plays as a major comorbid factor of COVID-19. According to The Centers for Disease Prevention and Infections (CDC), preliminary data allowed the researchers to speculate diabetes to be the most prevalent health condition existing in COVID-19 patients [4]. In addition, poor glycemic control has been linked to a higher mortality rate from COVID-19 [5]. Hence, glucose management is key for diabetic patients and a plant-based diet — high in fermentable fibers (soluble and insoluble) — can help improve glycemic control and help strengthen the immune system among patients with type 2 diabetes [6,7].

Focusing on lifestyle factors such as diet can allow an individual to modulate or strengthen their immune systems. A huge portion of our immune system consists of trillions of microbes- bacteria, fungi, and viruses – which inhabit on and inside the human body called the gut microbiome. Most of these microbes reside in our lower digestive tract. The human body is an exceptional metabolizer of carbohydrates, fats, and proteins. But, our bodies lack the proper enzymes to metabolize fiber. Fiber passes through the digestive tract unchanged until it reaches the colon. The gut microbiota is home to trillions of symbionts – good bacteria that live in symbiosis with us. We help them by providing fermentable fibers (insoluble & soluble) and they help us by fermenting it and producing Short-chain fatty Acids (SCFAs). SCFAs are produced during the fermentation of the fiber, which serve as the main source of energy for enterocytes (gut cells) and keep our gut happy and healthy. SCFAs produced as a by-product of the bacterial feast can enter the bloodstream and can help modulate our immune system [8] and lower inflammation in the gut and other organs [9]. 

So, what happens if our diet lacks adequate fiber? Typical western diet – high in processed foods, meats, sugar, and low in fermentable fibers (soluble & insoluble) – can decimate the good microbial communities in our gut microbiota. Many studies confirm the fiber intake for many average Americans is half of the amount recommended by  the American Dietetic Association (25g for women and 38 grams for men) [10]. Compared to other countries with high intakes of fiber [11], the microbiome of many Americans is less diverse in microbial communities and may be more susceptible to disproportions in good (beneficial) vs. bad (harmful) bacteria. This environment generated in the gut by the consumption of processed foods and lack of fiber — a trademark of the western diet — is a breeding ground for pathogenic microbes, which have the capability to initiate diverse forms of inflammatory diseases such as obesity [12] and type 2 diabetes [13]. 

The good news is that it is practical to increase your fiber intake. It begins with simple changes, like eating an orange and a cup of oatmeal with nuts for breakfast, or adding legumes (e.g., beans, lentils, etc.) to a salad or soup for lunch. Since plants (e.g., vegetables, nuts, and fruits) offer unique types of fiber with different health benefits, and some microbes may prefer one type of fiber over another, consuming a diverse diet with various fruits and vegetables is a cornerstone for optimizing the healthspan of the gut and the human body. Some of the primary principles in increasing fiber in your diet include the following: eat a nutritious, varied diet with a wide range of different plant-based foods, across all six food groups – fruits, vegetables, wholegrains, legumes (beans & lentils), nuts and seeds. Try to get as many different types as you can. Canned, frozen, fresh, it all counts. Eating the rainbow allows us to nurture a diverse microbial environment. If we eat well, the microbes eat well, therefore, we are more likely to feel well. 

References

1.    How Coronavirus Affects Older Adults. health.usnews.com/conditions/articles/how-coronavirus-affects-older-adults.

2. CDC COVID-19 Response Team. “Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) – United States, February 12-March 16, 2020.” MMWR. Morbidity and mortality weekly report vol. 69,12 343-346. 27 Mar. 2020, doi:10.15585/mmwr.mm6912e2

3. COVID-19 Provisional Counts – Weekly Updates by Select Demographic and Geographic Characteristics. 10 June 2020, http://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm.

4. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69:382–386. DOI: http://dx.doi.org/10.15585/mmwr.mm6913e2

5. Zhu, Lihua, et al. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-Existing Type 2 Diabetes. 1 May 2020, www.sciencedirect.com/science/article/pii/S1550413120302382?casa_token=Z62_Kb0zrqQAAAAA%3AYoK9OnCK2T3rHDULwhCYmLA4uF8PZGoCFbzYpK4qcYYC7ZQ_JhUvDT-OU_YzFNCjBJVnNT_SihvQ.

6.  Mcintosh, et al. “Diet Containing Food Rich in Soluble and Insoluble Fiber Improves Glycemic Control and Reduces Hyperlipidemia among Patients with Type 2 Diabetes Mellitus.” OUP Academic, Oxford University Press, 1 Feb. 2001, academic.oup.com/nutritionreviews/article/59/2/52/1826089.

7. Yokoyama, Yoko et al. “Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis.” Cardiovascular diagnosis and therapyvol. 4,5 (2014): 373-82. doi:10.3978/j.issn.2223-3652.2014.10.04

8. Arnolds, Kathleen L, and Catherine A Lozupone. “Striking a Balance with Help from our Little Friends – How the Gut Microbiota Contributes to Immune Homeostasis.” The Yale journal of biology and medicine vol. 89,3 389-395. 30 Sep. 2016

9.Sivaprakasam S, Prasad PD, Singh N. Benefits of short-chain fatty acids and their receptors in inflammation and carcinogenesis. Pharmacol Ther. 2016;164:144‐151. doi:10.1016/j.pharmthera.2016.04.007

10.UCSF Health. “Increasing Fiber Intake.” Ucsfhealth.org, UCSF Health, 31 Oct. 2019, http://www.ucsfhealth.org/education/increasing-fiber-intake.

11.Yatsunenko, Tanya et al. “Human gut microbiome viewed across age and geography.” Nature vol. 486,7402 222-7. 9 May. 2012, doi:10.1038/nature11053

12.Graham, Catherine et al. “Obesity and the gastrointestinal microbiota: a review of associations and mechanisms.” Nutrition reviews vol. 73,6 (2015): 376-85. doi:10.1093/nutrit/nuv00413.Wen, Li, and Andrew Duffy. “Factors Influencing the Gut Microbiota, Inflammation, and Type 2 Diabetes.” The Journal of nutritionvol. 147,7 (2017): 1468S-1475S. doi:10.3945/jn.116.240754

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