This year has been one of the most disruptive years that the world has faced in recent times. Numerous people were optimistic for 2020, some may have decided to adopt a healthier lifestyle by training and eating well, while others may have planned to invest their hard-earned income. Whatever the resolutions may have been, most of our plans for a productive 2020 were derailed by the arrival of COVID-19, with the first domestic case being reported in South Africa on March 3rd, 2020. The government enforced a hard country-wide lockdown from the 27th of March. Thereon, the population sequestered in their homes, social distancing from family and friends alike, to prevent the spread of the novel virus and keep loved ones safe. Along with being isolated came the abrupt change in lifestyle and the added concern for their own well-being, as well as concern for those close to them. COVID-19 has obviously been a disruption for the lives of many, financially and emotionally, but what impact has it had on the LCHF community and can a low-carb, high fat diet become a powerful weapon in fighting the pandemic?
Evidence suggests that those with existing comorbidities are at a far greater risk of developing complications while already infected and are more likely to suffer worse outcomes. However, the currently available evidence suggests that those with comorbidities, such as diabetes, heart disease, obesity and other diet-related diseases, are not at a higher risk for contracting COVID-19 in relation to those without chronic health conditions. So, if this is a case of simply being metabolically healthy, shouldn’t our diet be of interest in thwarting the virus?
A major contributor to diseases of lifestyle is a poor diet. The CDC reported in May that the most prevalent conditions of infected patients were cardiovascular disease (32%) and diabetes (30%). Their most likely contributing factor is a diet high in refined carbohydrates, simple sugars and starches. The above-mentioned health conditions have one thing in common, along with other health concerns they are collectively known as metabolic syndrome and this has a severe impact on proper immune function. This leaves a patient open to a number of complications during infection due to the impaired immune response of the body.
Due to the lockdown, many people are stock-piling their homes with non-perishables that are rich in sugar and carbohydrates, such as pasta, rice and cereals. We have learnt that not only is sugar bad for your teeth, but it may be bad for your blood vessels as well. Impaired glucose control has a negative impact on the free radical (FR) environment of the body. An imbalance in free radical and antioxidant concentrations can be partially attributed to consuming large amounts of carbohydrates. High concentrations of FR’s will eventually lead to DNA damage that will create an inflammatory response in the body. Previous studies have shown that inflammation in the lining of blood vessels will contribute to the formation of plaque, and may ultimately lead to the development of atherosclerosis, a condition associated with heart disease. This will, of course, bode poorly for those with T2DM as it may exacerbate the issue.
A common issue in diets high in carbohydrates and sugars is the accumulation of uric acid. According to Dr Neville Wellington, a diabetic expert, a direct driver of uric acid synthesis is the consumption of high amounts of fructose, a monosaccharide commonly found in fruits, which forms part of a high carb diet. Fructokinase, an enzyme responsible for the breakdown of fructose, essentially causes the depletion of ATP within the cell and the ADP produced by the process is used in synthesising uric acid. High uric acid levels have been linked to a number of negative health conditions, several being permanent bone, tissue, and liver damage. It is imperative to monitor the amount of fructose consumed as the body does not have a negative feedback system that can fundamentally shut off this process and prevent high uric acid levels from accumulating. Prior research that has been conducted has found a link between high uric acid levels in those with T2DM, non-alcoholic fatty liver disease and high blood pressure.
Currently, there are very few long-term studies available on how COVID-19 impacts individuals on an LCHF diet. This is mostly due to the fact that COVID-19 has not actually been around for very long, although we can compare it to a similar virus, Influenza (Flu). Both COVID-19 and Flu are respiratory diseases and are transmitted by contact, hence why it has been imperative to keep good hand hygiene and to practice social distancing during this time. A study conducted by Yale University in 2019 came to an exciting discovery, they learned that mice on a Ketogenic diet were able to better fend off the Flu. Mice that were fed a Ketogenic diet subsequently activated a specialized set of T-cells in the lungs, called Delta Gamma T-cells. These specific T-cells produce a mucus within the cell lining of the lungs that effectively neutralised some of the foreign virus particles upon entering the lung cavity. T-cells play an essential part in the immune system that is responsible for attacking foreign substances. Thus, mice raised on a Ketogenic diet were more likely to survive an influenza infection than mice raised on a high-carb diet. With more research, it may be possible that the same process could be observed in humans. Scientists have hypothesized that with further research, T-cells may play a huge role in the fight against COVID-19.
Luckily, for those of us following an LCHF diet, there is good news on the horizon. An ongoing research study conducted by the esteemed Johns Hopkins University has looked into ketones as a viable solution in combating the virus. They particularly focused on determining whether metabolic ketosis could reduce systemic inflammation and lessen the need for ventilator support in patients with acute respiratory failure. Intubated patients, infected with COVID-19, were administered a ketogenic dietary supplement whilst intubated. Their belief is that by inducing a ketogenic state the ketones will act as a drug-like signalling mechanism that improves immune and metabolic activity. A significant ketone body, beta-hydroxybutyrate (BHB), has been shown to provide a number of metabolic benefits, some being the prevention of cellular oxidative stress, a decrease in systemic inflammatory burden and the ability to inhibit nuclear factor κB (NF-κB) signalling, a protein that has been found to play a role in the development of many types of cancers. Seeing as COVID-19 wreaks havoc on the body by causing cellular damage, oxidative stress and an increase in free radical activity, it does appear that ketones as a treatment for the hyperactive inflammatory response caused by COVID-19 may be an effective and practical method for treating those infected.
There is reliable evidence suggesting that an LCHF diet, high in healthy fats and low in carbohydrates and sugars, is a steadfast method to improve metabolic health. In our previous blog post, we have mentioned benefits that include reducing blood glucose levels, reducing body weight, and effectively lowering cholesterol and blood pressure levels. It is, however, necessary to act with caution when it comes to exercising whilst infected. Although exercise is an important part of a healthy lifestyle, the body experiences fatigue whilst infected and unnecessary stress will prevent healing. To stay healthy and fit during the pandemic maintain a healthy diet by consuming foods high in vitamins, such as A, E and C, which have antioxidant properties – you can find them in foods such as kale, eggs, organ meats and almonds – and aid to improve immune system function. You can assist your body in achieving metabolic ketosis by reducing carbohydrate intake to less than 20 grams a day and eating moderate amounts of protein. Also, try to keep active during this time if you are able to do so safely. There is new ongoing research in the LCHF community that is certainly promising when it comes to the treatment of metabolic health concerns, and we’re hoping it will lead to not only a healthier population, but a safer method for treating those infected with COVID-19 too!
Currently, The Noakes Foundation’s community initiative, Eat Better South Africa (EBSA) has developed a program to assist under-resourced communities to meet their dietary needs and better their eating habits. You can visit our Eat Better South Africa website here to learn more about our community-based LCHF project. Also, visit The Noakes Foundation here to find out more about the benefits of an LCHF lifestyle.
The Nutrition Network is a wonderful education and networking platform founded by The Noakes Foundation. Dr Neville Wellington, who was mentioned in this article, has provided valuable knowledge on how an LCHF benefits those with T2DM and acts as a diabetic expert lecturer for the Nutrition Network. Specialised training courses have been curated for healthcare professions across all disciplines to gain knowledge on the latest and most up-to-date science and research in the field of Low Carb Nutrition. The purpose is to equip medical professions with the necessary skills on low-carb nutrition to practically apply it in their fields. You can visit the Nutrition Network here to learn more about their programs. The Nutrition Network has a free course on offer that pertains to COVID-19 and how the virus interacts with diabetes and obesity. You can find out more about the course presented by Dr Hassina Kajee here.
References
Goldberg, E.L., Molony, R.D., Kudo, E., Sidorov, S., Kong, Y., Dixit, V.D. & Iwasaki, A. Ketogenic diet activates protective γδ T cell responses against influenza virus infection. Science Immunology, 2019; 4 (41).
Demasi M. COVID-19 and metabolic syndrome: could diet be the key? BMJ Evidence-Based Medicine Published Online First: 10 July 2020. doi: 10.1136/bmjebm-2020-111451
Stubbs, B.J., Koutnik, A.P., Goldberg, E.L., Turnbaugh, P.J., Verdin, E. & Newman, J.C. (12 July 2020) “Investigating Ketone Bodies as Immunometabolic Countermeasures against Respiratory Viral Infections”. Retrieved from Med: https://doi.org/10.1016/j.medj.2020.06.008
Baker, L. (2000, August 16). Study Shows Glucose Consumption Increases Production of Destructive Free Radicals, Lowers Level of Key Antioxidant. Retrieved from University at Buffalo: http://www.buffalo.edu/news/releases/2000/08/4839.html
Yale University. (15 November 2019) “Ketogenic diet helps tame flu virus”. Retrieved from ScienceDaily: www.sciencedaily.com/releases/2019/11/191115190327.htm
Ryding, S. (2020, June 17). What are T Cells? Retrieved from News Medical Life Sciences: https://www.news-medical.net/health/What-are-T-Cells.aspx
Mullens, A. (2020, July 24). Ketones and low carb in the time of Covid-19: Helpful or harmful speculation? Retrieved from Diet Doctor: https://www.dietdoctor.com/ketones-and-low-carb-in-the-time-of-covid-19-helpful-or-harmful-speculation
About the author:
Shannon Mace has a BSc degree in Human Life Sciences from Stellenbosch University, she majored in biochemistry and physiology. She has a keen interest in metabolic physiology and hopes to further her studies in the subject. Shannon has joined The Noakes Foundation as a researcher, as well as an administrator. She looks forward to helping the foundation promote healthier living and happier lifestyles.
