The cytokine storm is the major cause of death from the coronavirus! The cytokine storm is a severely dangerous hyperimmune reaction to infection of the coronavirus in the lungs, in which the immune system overproduces inflammatory cytokines, which can damage lungs and cause inflammation of the air sacs of the lung, which can inhibit oxygen in the body – causing pneumonia, respiratory failure and the requirement of a ventilator. Recent research has shown that the cytokine storm can also cause inflammation and cell damage to the heart, liver, brain, kidneys, intestines, as well as cause abnormal blood clots, which are causing lower body amputations and sudden cardiac thrombosis and death.
In those people infected with the COVID-19 virus, the coronavirus particles enter your body through your nose, mouth or eyes, into your lungs. The immune system recognizes the virus and sends immune-signaling molecules called cytokines such as interleukin-6 (IL-6) and tumor necrosis factor (TNF). Normally these cytokines play a beneficial role by activating our innate immune response and certain white blood cells called macrophages, neutrophils and natural killer cells that destroy and kill certain dangerous pathogens, bacteria and viruses. These white blood cells are like “killer, phagocytic Pac-Men” that release reactive oxygen species (ROS) free radicals and kill these bacteria and viruses. At the same time, these ROS free radical species damage normal tissues and cause inflammation and cell death. So these white blood cells in fact are a two-edged sword – they kill dangerous viruses and bacteria or they can go haywire, causing severe inflammation cell damage and organ failure!
The anti-inflammatory drugs approved for treating rheumatoid arthritis such as tocilizumab (Actemra) has great potential in treating COVID-19 patients with the deadly cytokine storm. Also, the inexpensive generic steroid drug dexamethasone reduces death rates by one-third with the most severe cases of infections. It is a major breakthrough treatment. These anti-inflammatory drugs reduce inflammation and tame down the cytokine storm and hyperactive immune response in some very ill patients. These drugs also have many side effects, but the benefits far outweigh the risks and can potentially save many lives!
Also, as early as 2005 “The FDA warned that taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen increase risk of having a heart attack or stroke.” (Sources: Harvard Health Publishing, July 13, 2015) Many people abuse these NSAIDs for pain and inflammation. It’s important to take these drugs under the supervision of a physician and take the lowest effective dose for the lowest length of time.
The Mediterranean diet, an anti-inflammatory diet, has great potential to naturally help tame down the uncontrolled hyperimmune response, which causes the potentially deadly cytokine storm and severe inflammation. The Mediterranean diet is the healthiest diet based on the latest scientific research. A healthy diet and lifestyle changes, such as following the anti-inflammatory Mediterranean diet along with exercise, has been shown to lower the risk of obesity, metabolic syndrome and high-risk ailments such as cardiovascular disease and diabetes. For the past two years, US News and World Report ranked the Mediterranean diet as the best overall diet for healthy eating, tied with the Dash Diet. The Mediterranean diet was also ranked #1 for the easiest diet to follow; best diet for diabetes; best heart-healthy diet, and best plant-based diet too. The Mediterranean diet is high in fish containing omega-3 fatty acids, in addition to antioxidant-rich vegetables, red wine and berries rich in polyphenols, beans, lentils, nuts, legumes and extra-virgin-olive oil that are rich in healthy monounsaturated polyunsaturated fats and low in saturated fats. A recent study by Harvard researchers and reported by the American Heart Association (March 5, 2020) and published in the Journal of the American College of Cardiology (March 2020) found that as little as half a tablespoon of olive oil a day was linked to significant decrease in cardiovascular disease. Research has shown that omega-3 fatty acids (primarily EPA and DHA) found in fatty fish such as salmon have potent anti-inflammatory properties and reduced inflammation and protect against heart disease. It was reported recently in the Wall Street Journal (June 3, 2020) that, “Amarin Corporation plans to test it’s fish oil derived drug Vascepa, can prevent and treat COVID-19 infection and reduce the risk of cardiovascular problems in patients who sustain heart damage during their illness.” This story added: “Amarin says Vascepa may help prevent or treat inflammation.”
Omega-3 fatty acids (EPA and DHA) both lower inflammation. Some research has shown that DHA is a more anti-inflammatory than EPA. These omega-3 fatty acids can lower inflammatory compounds called leukotrienes in the body. These leukotrienes are produced naturally from arachidonic acid, a polyunsaturated fat found in animal fats present in meat, poultry, eggs and cheese. High arachidonic acid levels in the body can increase inflammation and the inflammatory cascade, which can lead to the cytokine storm in susceptible individuals. That’s why it’s very important to limit animal fats and arachidonic acid in the anti-inflammatory Mediterranean diet and eat more omega-3 rich fish such as salmon.
Research has shown that inflammation is a major risk factor for cardiovascular disease. Research has shown that the traditional Mediterranean diet can reduce inflammation and improve cardiovascular health (Nutrients, August 9, 2020). Sixteen years ago the ATTICA Study (J Am Coll Cardiol, July 2004) found that the Mediterranean diet was associated with a 20% lower c-reactive protein (CRP) and 17% lower levels of interleukin-6 (IL-6.) CRP and IL-6 are elevated in systemic inflammation in the body. This was an observational study and demonstrated an association but not proof of cause and effect like a randomized, double-blind clinical trial; also, a similar study a year later called the Nurses’ Cohort in the USA (Am J Clin Nut, July 2005) was associated to a 24% lower c-reactive protein and 16% lower levels of interleukin-6 (IL-6). These very well conducted observational studies were later confirmed by a randomized clinical trial (PREDIMED pilot study). The Mediterranean diet supplemented with extra-virgin olive oil for three months that human adults followed reduced c-reactive protein. The Mediterranean diet, as I mentioned, was supplemented with extra-virgin oil containing monounsaturated fats and polyphenols and lowered low-grade inflammation implicated in the mechanism leading to atherosclerotic disease (Nutr Metab, September 2014). The PREDIMED trial later involving 1,139 high-risk cardiovascular adults further confirmed a dose-dependent anti-inflammatory of the Mediterranean diet rich in polyphenols based on measuring inflammatory biomarkers such as c-reactive protein and interleukin-6 (Br J Clin Pharmaca, January 2017). A later study (CANTOS trial) found that a monoclonal antibody that reduces c-reactive protein and interleukin-6, and inflammation, further confirmed the inflammatory hypothesis in atherosclerosis and cardiovascular disease without lowering blood lipids (N Engel J Med, Jan. 1999, Endocrinol Diabet Nutr, Nov. 2017). The Mediterranean diet containing extra-virgin olive oil, fruits, and red wine is rich in polyphenols with potent anti-inflammatory properties.
Recently, the Cleveland Clinic published a scientific review (June 2, 2020, Cleveland Clinic Journal of Medicine) entitled, What is the role of supplementation with ascorbic acid, zinc, vitamin D, or N-acetylcysteine for prevention or treatment of COVID-19? The review mentioned that zinc, vitamin D, and N-acetylcysteine (NAC) can lower proinflammatory cytokines such as interleukin-6 (IL-6), interleukin-1 (IL-1) and tumor necrosis factor (TNF). The authors outline, “the biological plausibility, applicable clinical data and potential role of each of these agents.” The Cleveland Clinic Investigators continued to say that, “several agents intended to supplement dietary intake or indigenous molecules may have a theoretical role in preventing or treating COVID-19.” Based on their scientific review, the authors further acknowledge that “ascorbic acid, zinc, vitamin D, and N-acetylcysteine have biologic plausibility for prevention and treatment of COVID-19 and are candidates for clinical trials evaluating patients with these indications.”
In conclusion, it is now reported that 1 in 5 people are at high risk of COVID-19. The coronavirus is not just going to disappear. It’s going to be with us for a while. We need to improve our health and lower our risks of getting COVID-19. We already know that people over 65 have higher systemic inflammation. Also, systemic inflammation is higher in overweight and the obese. Also, with pre-existing ailments such as metabolic syndrome, hypertension, diabetes, heart and cardiovascular disease increase systemic inflammation and risk of death from COVID-19. A healthy nutritional diet and lifestyle such as the anti-inflammatory Mediterranean diet may help lower inflammation. Clinical trials with the Mediterranean diet need to be done, and evaluated in people at high risk of COVID-19. Even though cases of coronavirus are going down and less people dying, we cannot take our foot off of the pedal! 40% of adults are obese in the United States. Many have metabolic syndrome and systemic inflammation. A simple blood test by your physician can measure your c-reactive protein levels. Eating healthy and improving our metabolic health and exercising more can help control our weight, lower inflammation, and improve our metabolic health.