Increasing the Probability of Effectiveness
Even without FDA approval and the right to publicly claim effectiveness, using whole foods can still be effective in treating COVID-19. We increase the chance of effectiveness against the virus by applying the drug combination therapy principle to whole foods. We do this by creating a meal plan that is:
- Nutrient-dense to ensure we are not deficient in complex carbohydrates, lean protein, healthy fats, vitamins, minerals, and probiotics. These are all needed to boost our immune system to be optimal.
- Antiviral to possibly stop the coronavirus from infecting and replicating.
- Anti-inflammatory to control the inflammation caused by the excessive immune response needed to fight off the infection.
- Easy and safe to start and stick to.
Nutrient-Dense
Your body needs a large variety and amount of nutrients to build a healthy immune system. I believe the best way to boost your immune system is to eat a good variety of nutrient-dense whole foods. Eating a diet of mostly processed foods causes nutrient deficiencies and makes your immune system weak. As food is more processed, more nutrients are removed. For example, processing an orange to vitamin C reduced the number of phytonutrients from 170 to one. For most people, eating whole foods regularly should provide more than enough essential macronutrients, micronutrients, and probiotics to eliminate these deficiencies that prevent your immune system from being optimal and to stimulate the immune system to be in peak form to fight the virus. There is no need to take additional immune-boosting supplements.
Antiviral
Since the antiviral effects of whole foods are unproven, eating a meal plan consisting of whole foods with possible antiviral effects increases the probability that at least one of them will be effective against the coronavirus. Currently, pharmaceutical and biotech companies are testing their chemicals and biologics against the virus. Instead of running a clinical trial on one drug candidate and hoping it is effective in stopping the virus without any serious side effects, I propose we should run a thousand clinical trials to test a thousand different chemicals. Instead of using a sniper rifle, we should be using a machine gun to kill the virus. Instead of buying one lottery ticket, we buy a thousand to increase our chance of hitting the jackpot, an effective treatment for COVID-19. Where would we get a thousand chemicals to test, you may ask? The whole foods listed in our meal plan contain this large variety of chemicals. As I mentioned before, an orange has about 170 kinds of phytonutrients. If a fruit, vegetable, or herb hypothetically has an average of 100 different types of phytonutrients each, eating a variety of 10 together will provide your body with 1,000 different types of phytonutrients. We increase our chances of success by 1,000 times to find one phytonutrient that can stop the virus. If two phytonutrients in the meal plan are effective against the virus, we increase our chances of success by 2,000 times. A potential drug can be effective but have serious side effects causing it to fail clinical trials. When we factor in that most whole foods usually have no serious side effects, our chance of success is even higher compared to current drug candidates being tested against the coronavirus in clinical trials.
| Drug Candidates | Number of Chemicals (Chances of Success, Lottery Tickets) |
|---|---|
| remdesivir | 1 |
| hydroxycholroquine | 1 |
| hydroxycholoroquine + azithromycin | 2 |
| hydroxycholoroquine + azithromycin + zinc | 3 |
| dexamethasone | 1 |
| Vitamin D | 1 |
| Vitamin C | 1 |
| Vitamin C + zinc | 2 |
| Emergen-C | ~20 |
| Whole orange | 170 |
| 10 whole foods | >1,000 |
The use of multiple methods to increase the chance of success is seen everywhere and is based on statistics. In professional sports, general managers are responsible for selecting players to form a team that can win. Using data analytics in 2002, Oakland Athletics' General Manager Billy Beane identified statistics to predict how many runs a player would score and created a winning team despite being the third poorest team. Since then, the use of statistics has dominated professional sports.
In the investment world where I used to work, portfolio managers and investors invest in a portfolio of companies to create funds to hedge and optimize their investment returns. Harry Markowitz and William Sharpe, two economists who won the 1990 Nobel Prize in Economics for their contribution to Modern Portfolio Theory, used math to show that owning different kinds of financial assets is less risky than owning only one type. This is why over 90 percent of managed investment funds are unable to beat the S&P 500 for the past 15 years and why investing in index funds have become so popular. This diversification is now being used in almost every industry to manage risk and get the best return on investment. Even superheroes know that a combination of various superpowers is needed to defeat a powerful villain. Hence, the Justice League and the Avengers were formed. We have used the same approach to create our meal plan by using a variety of whole foods to increase our chances of finding an effective antiviral against the coronavirus.
Anti-inflammatory
If you become infected with the coronavirus, tissues in your respiratory tract will become inflamed due to your immune system's response to the infection. Many of the signs and symptoms of the infection are caused by inflammation. This inflammation is the result of the collateral tissue damage caused by the immune system's all-out fight against the virus. This inflammation of the lungs is one of the causes of shortness of breath in infected patients requiring the need for ventilators. The antimalarial drugs, hydroxychloroquine or chloroquine, being touted by some as a game-changer in the war against the virus, are more commonly used as anti-inflammatory drugs. Hydroxychloroquine is widely used to treat lupus and rheumatoid arthritis. Both are autoimmune diseases. I believe one of the reasons these antimalarial drugs may work is because they reduce lung inflammation.
Our meal plan needs to be anti-inflammatory to reduce symptoms of respiratory infection. We need foods that will be able to suppress an overactive immune system and reduce excess inflammation. Whole foods are rich in antioxidants and other anti-inflammatories. What we do not need are high doses of antioxidants found in supplements to suppress the immune system excessively so that it is too weak to fight the virus.
Besides eating anti-inflammatory whole foods, we need to also avoid foods that cause inflammation. Many foods are believed to cause inflammation, such as red meat, processed meat, dairy, gluten, and lectins, especially if you are allergic to them. If we exclude these foods from our meal plan, there would be not much to eat, and the meal plan would be too restrictive for most people. Therefore, we will recommend avoiding foods that have the most scientific evidence of inflammation: sugar, salt, and fried foods.
Sugar Increases Immune System Suppression and Inflammation
Many antiviral and anti-inflammatory foods are fruits that have sugar. Juicing them will increase the sugar amount. A cup of orange juice has four teaspoons of sugar (21 grams), while a cup of pomegranate juice has 8.5 teaspoons of sugar (34 grams). Sugar suppresses the immune system and causes inflammation. Having high blood sugar levels is the reason why pre-diabetics and diabetics patients have a higher risk of infections. Therefore, any supplements to fight viral infection should have as little sugar as possible. Emergen-C has 6 grams of added sugar. Airborne is sweetened with sorbitol, a sugar alcohol that causes gastrointestinal disturbances, and the controversial artificial sweetener, sucralose (Splenda), believed to cause cancer and diabetes. Artificial sweeteners, like sucralose and aspartame, also are associated with inflammation. Remember, sugar comes in many forms, such as be fructose found in sweet fruits as well as refined or simple carbohydrates found white bread, pasta, white rice, desserts, and snacks. Constant high blood sugar increases insulin resistance causing type 2 diabetes and obesity. Both are risk factors for COVID-19 deaths.
Salt Increases Immune System Suppression and Inflammation
Animal and human studies show that high salt intake causes inflammation and impairs the immune response. Salt also increases glucocorticoid levels, a stress hormone that suppresses the immune system. Mice on high salt diets had higher bacteria infection rates and incidence of autoimmune diseases. Given this limited evidence, we add this low salt restriction to our meal plan since eating excess salt is also a leading cause of hypertension. According to the CDC, about 45% of adults in the United States have hypertension or taking medications for hypertension. Hypertension is one of the underlying medical conditions that make people have a higher risk of severe illness from the virus.
Fried Foods
In the past, foods that were fried, especially fast food, used hydrogenated oil that caused inflammation and cardiovascular disease. Hydrogenated oils, also known as trans fats, were cheaper, had a long storage life, and needed to be changed less when used to fry foods when compared to natural oils. In 2018, the FDA banned all artificial trans fat. However, non-hydrogenated vegetable oils, such as canola, soybean, and corn, still contain some amount of trans fat. As the oil is heated during the frying process, the amount of trans fat increases. Regularly eating fried foods also adds excess and empty calories that will eventually lead to obesity, cardiovascular disease, and diabetes - all COVID-19 risk factors. Therefore, it is best to avoid fried foods to reduce unnecessary inflammation and calories when fighting off a viral infection.
Medication Adherence and Compliance
In pharmacy, there are two major behaviors that make medications more effective. Medication adherence is the behavior where patients fill or refill prescriptions on time. Medication compliance is the behavior of taking the medication on time and as prescribed. Because the meal plan is based on combination drug therapy, it is most effective when all the foods in it are eaten together each day. Like an antibiotic, it must be taken consistently to make sure that you have effective amounts of phytonutrients in your body at all times. When the meal plan is not taken daily, levels of phytonutrients become too low to be effective to stop virus replication or control excess inflammation. In order to promote these two behaviors, we have to make the meal plan easy and safe to start and stick to.
Importance of Common Whole Foods
Our meal plan needs to consist of common foods that you can get from any grocery store. We avoid exotic foods for many reasons. First, exotic foods are hard to find. Limited availability of any food makes mass adaptation of the meal plan difficult. Second, verifying the food quality and purity of exotic foods is difficult since a lack of competition and food regulations allow vendors to cut corners. Third, exotic foods have limited medical research on effectiveness, safety with long-term use, and food-drug interactions. Fourth, educating consumers about exotic foods is hard. Most people are fearful of the unknown. Educating Americans on the health benefits of an orange is a lot easier than teaching them about an exotic herb with a long Latin name only found in Asia. Fifth, using common foods will increase consumer confidence that it is safe to eat regularly with their existing prescription drugs without any negative health consequences. Finally, using common foods drastically reduces liability risk for healthcare professionals who recommend the meal plan. Proving a common fruit or vegetable is toxic, especially if it is organically grown, eaten in a safe amount, and screened for drug interactions, will be very difficult in a malpractice lawsuit.
Importance of Flexible Meal Plan
During my third year of pharmacy school, I worked in Genentech's Marketing Department to set up a medication compliance program for their respiratory drug, Pulmozyme. Besides learning a lot about lungs, I became an expert on factors that motivate people to keep taking their medications. Sticking to the meal plan is very difficult. Very few people will be able to stick to all the foods and strict guidelines in the meal plan. Eating healthy whole foods is nearly impossible for most people, but asking most people to eat them every day is even more impossible. Therefore, the meal plan needs to be flexible, allowing occasional food omissions, substitutions, and alternatives. An occasional sweet, salty, or fried treat is allowed. However, I hope the fear of death or long-term, multiple organ damage will motivate more people to strictly follow the meal plan if they are at high-risk or once they become infected with the virus.
Importance of Simple and Concise Meal Plan
I have read many nutrition books and articles about different diets. Most of them include a meal plan. Some meal plans are just a list of foods to eat or avoid. The better ones include complicated recipes that tell people what to eat each meal for each day. Based on my knowledge about medicine compliance, I believe we need to find a balance between these extremes. If a meal plan is too simple and loose, it will be less effective. If it is too complicated and strict, nobody can remember or follow it. Pharmacists have perfected the art and science of making people take their medications. If we apply these principles to make the meal plan, we will increase the chance that people will stick to the meal plan. If I was your pharmacist, I would not give you a bottle of pills and not instruct you on how to take it, how many times to take it, whether to take it with meals, or what serious side effects to watch for. Without clear instructions, you will take your medication wrong. Taking too little medicine will not be effective, but taking too much could be dangerous. In both scenarios, you will most likely stop taking your medication. In the other extreme, if I tell you too much information, you will forget how to take it or be too scared and not take it at all. This is why pharmacists, when they consult patients on new drugs, are very concise with their instructions: what the drug is for, how many times to take it, how to take it, and serious side effects to look for.
The meal plan that I created is simple and flexible enough to follow, but detailed enough to be effective. I broke down the meal plan to a few guidelines and grouped the foods into categories. These categories are then grouped into recognizable and memorable core dishes: a salad, a fruit salad, and a drink that needs to be eaten every day. The salad can be used in a wrap, a burrito, a pizza, stir-fry, or soup. I even included a smoothie for busy and sick people that blends the salad, fruit salad, and tea. Allowing ingredient substitutions and alternatives to these dishes will add a variety of taste to the meal plan. Taste is important in medicine compliance. It is also important in eating healthy. The whole plan fits onto one piece of paper, and I have named it the "Immunity Meal Plan".
See Immunity Meal Plan
Meal Plan Guidelines
Now that you know the theories behind the Immunity Meal Plan, let me summarize the guidelines of the plan:
- Must contain whole foods to be as nutrient-dense as possible.
- Must contain whole foods with antiviral activity.
- Must contain whole foods rich in antioxidants and anti-inflammatories.
- Must contain no added sugar or refined carbohydrates.
- Must be low in salt.
- Must not be fried.
- Must contain whole foods commonly eaten and widely available.
- Must be flexible and allow food omissions, substitutions, and alternatives.
- Must be simple and concise.