OPINION | Chronic diseases, immunity and nutrition. Nutrition is important now more than ever!

  • People who are obese and suffer from comorbidities have a higher chance of dying from Covid-19
  • The South African statistics relating to obesity and chronic diseases are cause for great concern
  • Fortunately, changing to a healthier diet can significantly lower one's risk of dying from Covid-19 and other diseases

We have reached Lockdown level 1, which is a great relief as the economy can slowly recover, more people can go back to work and we can regain a sense of normality in our daily lives – while taking the correct precautions of course. 

However, it seems that many people have let their guard down. People are out and about without masks, not washing their hands or rigorously sanitising, and not practising physical distancing. This is a recipe for disaster and new infections. We should at all costs try to prevent the second wave of infections. 

The role of comorbidities

Now is not the time to be complacent. It is important that you follow the basic rules of hygiene and physical distancing, and improve your nutritional intake to help improve your immunity, especially if you have a chronic disease.

Studies on Covid-19 from around the world have shown that patients who have died tended to have comorbidities such as diabetes, hypertension, cardiovascular disease, kidney disease and cancer. Obesity has also increased the severity of the infections, with many obese patients being hospitalised in intensive care units.

Even more concerning is that these chronic diseases and inflammation increase with age, which is why the elderly are so much at risk.

South Africa an obese nation

The South African Demographic and Health Survey (SADHS), completed in 2016, has shown shocking statistics in relation to obesity and chronic diseases. They found 68% of men and 31% of women to be overweight and obese, with 20% of women and 3% of men being severely obese. Hypertension is present in 46% of women and 44% of men.

Diabetes is the second, and cardiovascular disease the fourth leading cause of death in South Africa. Chronic diseases are, therefore, a huge concern for the health system in South Africa, and the prevalence of these conditions is increasing at an alarming rate.

Obesity is a chronic inflammatory state and is linked to many chronic conditions such as diabetes, cardiovascular disease, hypertension, kidney disease and cancers. Even if you are not obese, any chronic disease has underlying inflammation associated with it. It is due to this inflammation that diseases are termed chronic.

Chronic inflammation is linked to many alterations in the immune system, which must always be alert to the invasion of organisms that may harm the body. The immune system consists of many cells which all have different roles to play to ensure proper immune functioning. Most of the immune cells in the human body are found in the gut. When we ingest food, we expose ourselves to near-constant immune responses, and our immune system must provide protection against invasive pathogens, while still tolerating food proteins and bacteria that are already present. 

Benefits of a Mediterranean diet

Nutrition is very important to ensure the proper functioning of the immune system. Many nutrients have specific roles to play in the development and maintenance of an effective immune system and preventing chronic inflammation. The Western diet is a known risk factor for chronic inflammation, and is characterised by a high intake of sugar, trans and saturated fats and salt, while being low in fibre, fruits and vegetables, bioactive compounds, polyphenols and healthier fats, including omega 3’s.

In contrast, a Mediterranean diet is associated with a reduced risk of chronic diseases such as cardiovascular disease and cancer. This diet is rich in fruits and vegetables, nuts, seeds, legumes, whole-grains, low-fat dairy, fish, olives, and olive oil. Although red wine is also a feature of this diet, it is not risk-free and should be used cautiously especially in the presence of chronic disease conditions and obesity. 

What also needs to be considered in these challenging Covid times is the fact that many people have lost their jobs and have limited food availability. Although processed food may offer a quick and cheaper option, it should be avoided due to its high fat, salt, sugar and additive content.

To improve your nutrition, follow the following tips to ensure a natural and healthy diet:

  • Increase your intake of cooked legumes, such as beans, lentils and soya. These foods are more affordable and extend dishes. There is a multitude of different beans that be consumed, such as kidney beans, baked beans, black-eyed beans, sugar-beans, black beans, cannellini beans and chickpeas. There are so many different dishes that can be made with legumes, including dhals, wraps, salads, curries, stir-fries and tortillas to mention a few. This also provides a good source of protein, besides the fibre and other nutrients.
  • Plan your vegetable intake before planning the rest of your diet. Try to include a variety of colours and tastes daily. It can make dishes so much more interesting and it also makes you feel fuller. Some affordable examples include all types of salads, broccoli, cauliflower, carrots, baby marrows, spinach and cabbage. Start a vegetable garden at home, so you will have a constant supply of fresh vegetables. Also remember some vegetables last longer, so opt for these if you have limited shopping trips. Frozen vegetables are also a healthy alternative. Have at least three to four portions of vegetables a day. Fruits are a good option as a healthy snack. Two to three portions are allowed a day. One cup of raw veg, such as salad or half a cup of cooked vegetables is one portion. One tennis ball size of fruit or a half cup of chopped fruits is a portion.
  • Choose whole-grains over more refined carbohydrate options. Include brown or whole-wheat breads, cereals, rice, pastas and maize meal. Starchy vegetables such as potatoes, sweet potatoes, butternut and sweetcorn.  Limit sugar and sugary foods as much as possible. Don’t drink your calories, avoid cooldrinks and juices. Drink water daily. If you need a fizz occasionally, choose low energy and diet cooldrinks.
  • Choose low-fat protein options. Choose fish and skinless chicken over red meat. Don’t fry your proteins, rather steam, boil, bake or braise or cook in the pot with a small amount of oil. Eggs are a cheaper source of protein, but not more than three to four times a week and preferably boiled or poached.  Frying foods at high temperatures and especially with reused oil increases inflammation. When choosing fish, try to include some oily fish such as pilchards, sardines, snoek and salmon, even though salmon is more expensive. Choose low-fat dairy options. Avoid cheaper, processed meats such as polony, sausages, pies and burgers.
  • Limit salt and salty foods as much as possible. Rather choose herbs and natural spices such as mixed herbs, origanum, basil, garlic, lemon juice, paprika, pepper, chilli powders, cumin, turmeric and coriander. Avoid using mixed spices and limit the use of sauces.
  • Limit portion sizes. Every individual has different nutritional requirements and needs different portion sizes. It would be best to consult with a dietitian regarding specific portions; obtaining advice (especially if you have a chronic disease); as well as a full nutritional assessment. A rough guide is half your medium-sized plate with vegetables, a quarter with protein and a quarter with starch.
  • Be mindful when you eat, eat slowly, and enjoy your food.
  • Exercise most days of the week. Walking, jogging, swimming, Pilates, yoga, dancing and going to the gym are all good forms of exercise. Besides helping to build your immunity, it also helps to improve mental health. Start slowly and build up your time; you should do at least 150 minutes of exercise a week and include some muscle-strengthening exercise. Check with your doctor before starting an exercise plan if you have a chronic condition.

Zarina Ebrahim is a registered dietitian and lecturer at the Division Human Nutrition, Department Global Health, at Stellenbosch University.

Image credit: Pexels
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