Covid: nutrition is part of the solution

By Eilish Blade

Overwhelmed by data on Covid-19? Well, Covid fatigue is hard to escape these days, which means that we may be missing an important point. Current strategies to deal with the pandemic are dominated by global health security and a focus on infectious disease. The Lancet however recently challenged this narrow focus, saying that in reality we have a 30-year failure in tackling diet and lifestyle-related disease. We have seen the headlines linking metabolic illnesses such as diabetes, cardiovascular disease, hypertension and obesity with severe outcomes from Covid. Right now, we have what is now more aptly called a syndemic. A syndemic is the interaction of two categories of disease within specific populations; in this case, SARS-CoV-2 on the one hand, and non-communicable diseases on the other. Crucial to the synergistic power of Covid and metabolic disease is a background of socio-economic inequality.

In case we weren’t aware, the NHS was already  struggling with the costs of these diseases. In 2006–07, diet-related ill health cost the NHS £5.8 billion, the cost of physical inactivity was £0.9 billion and overweight and obesity cost £5.1 billion. The WHO had already predicted that by 2020 chronic disease would account for nearly three-quarters of all deaths worldwide, and that in developing countries 70% of all deaths would be due to diabetes and associated complications. As if the picture isn’t gloomy enough we have a ticking time bomb of our own as Wales has the highest prevalence of diabetes in the UK with a cost of £500 million a year. More than 580,000 people are at risk of developing type 2 diabetes and this puts it as the fastest growing health crisis in Wales. 

With all of this in mind, and the data which shows that those with a high Body Mass Index (BMI) and metabolic disease are disproportionately affected by Covid, where is the preventative strategy? Given that it was clear back in May 2020  that poor nutrition was a critical part of the problem, why are we now well into a second wave with no mention of diet and lifestyle? To rub salt into the wounds we also had to endure the “Eat out to Help Out’’ campaign in August, only to later hear Boris Johnson admit that the campaign may have been influential in spreading Covid. Having a McDonald’s for half price was a double whammy.

As the nutrition and obesity expert Dr Zoe Harcombe puts it, “obesity is a natural response to an unnatural diet”. Yes, I’d say that’s it in a nutshell, as real food doesn’t come with a list of ingredients straight from the chemistry lab. As a Registered Nutritional Therapist and an Ambassador for the Real Food Campaign I am passionate about the role of food as medicine and now more than ever,  I find myself on a mission. Real food contributes to a nutrient-dense diet and while eating a wide variety of foods is important for our macro and micro intake, the quality of our food is more important than the quantity. Eat out to Help Out could have taken on a whole new flavour if the focus had been real food and all ultra-processed food and drinks had been off the menu.

So how is Wales responding to its own obesity and metabolic health crisis since Covid? February 2020 saw the launch of the 2020-2022 Delivery Plan as part of Healthy Weight, Healthy Wales strategy only to have to change tack when priorities shifted to Covid. This was understandable initially, but given that we seem to be now running a marathon not a 100m, then surely  diet and lifestyle are crucial? While Healthy Weight, Healthy Wales is on pause, our shopping, cooking and dietary patterns have taken an unprecedented shift since March. An unfortunate consequence of lockdowns is the negative effects on physical and mental health with 63% of people in Britain reporting that they are eating less healthily due to stress, anxiety and tiredness. When nearly half the country is not feeling motivated to eat well, and factoring in the rise in job losses and economic hardship, we are creating the conditions for a rapid growth in obesity and diabetes. Are we going to veer from one crisis to the next?

If ‘’following the science’’ meant just that, then we would be doing something about vitamin D. Deficiency of vitamin D is found in over 80% of hospitalised Covid patients, and it is a key feature in metabolic conditions such as type 2 diabetes, obesity, cardiovascular disease and insulin resistance. In one study, severely ill hospitalised Covid patients who received Vitamin D plus the anti-viral hydroxychloroquine and the antibiotic azithromycin saw a 98% reduction in ICU admissions and all were discharged with no complications and no deaths. The simple step of supplementing vitamin D on a national level – which incidentally we should already be doing between the months of October and March, according to government guidelines – and/or testing and supplementing all Covid-19 patients and high-risk-persons, should be implemented as a matter of urgency. Sadly, the NHS says that there is insufficient evidence to demonstrate that vitamin D supplementation can prevent Covid. This may be true, but vitamin D may still prevent more severe outcomes, and it is by definition necessary for those who are already deficient. Testing and supplementation are inexpensive and could be easily applied through GP surgeries as part of a wider strategy to reduce the burden on the NHS.

We now know that Covid-19 is a disease which is perpetuated by oxidative stress. Oxidative stress is an imbalance of free radicals and antioxidants in the body, which can lead to cell and tissue damage. It occurs naturally and plays a role in the ageing process, which is why the elderly are more vulnerable to the virus. A pre-existing state of oxidative stress will only worsen outcomes for those who contract SARS-CoV-2and again the message is that diet and lifestyle are crucial. Increasing our levels of protective antioxidants starts with a nutrient-dense diet and healthy lifestyle. Studies have found lower levels of the master antioxidant glutathione in patients with moderate and severe Covid.

Other nutritional deficiencies have been highlighted. Zinc supplementation has potential as a treatment in the early stages of the virus and during the disease progression, particularly in those with chronic illness and the elderly. More studies are showing that a high dose of vitamin C can improve recovery time in clinical settings. We are not espousing woo-woo and maggot therapy…this is the science!

Political failures must also be acknowledged in the context of this catastrophe and will continue to impact outcomes both from Covid-19 and the management of underlying health conditions.  We have the potential now to really do things differently.  In a statement from the Real Food Campaign, Recovery from Covid-19 comes the following call to action:

‘’The Real Food Campaign UK is adding its voice to the increasing number of concerned citizens and groups from every part of society – doctors, healthcare practitioners and health workers, academics, chefs, regenerative and sustainability-led farmers and small food producers and retailers. We are demanding that the Government and public health agencies take urgent action to recognise and address the impact that food quality and methods of food production have on the health and the quality of life of every UK citizen and ultimately, on our planet.’’

A healthier Wales, with less metabolic disease, would give us some protection from Covid-19 and possible future viruses. Given that nutrient deficiencies and low antioxidant status are risk factors for severe outcomes from Covid, what should we eat? A varied plant-based diet is key to nutrient density, but certain animal foods are also vital, such as oily fish, eggs and liver which can all provide vitamin D and A; without these, we may need to take  supplements. Wales is in a unique position to promote a healthier national diet through the collaborative working encouraged by the Well-being for Future Generations Act. We must focus on nutrient-dense wholefoods which should be produced in ways that support health and be free from chemicals. To make this happen we must bring together health, food and farming, We also need education  at every level on the importance of real food. It is integral to our health.

Eilish Blade is a Registered Nutritional Therapist and a member of the Complementary and Natural Healthcare Council. She has a background in horticulture and permaculture. She is the owner of Blade Clinic and you can read her blogs at www.bladeclinic.co.uk

Nose to tail eating – more nutrients, less waste

by Eilish Blade

Eilish Blade

Eating less meat is a core principle of a sustainable diet, but we tend to forget about offal, the meat that comes from an animal’s organs which is rich in nutrients. As an MSc student in Nutritional Therapy, I’m interested in health outcomes and the nutrient density of food Could. “nose to tail” eating be the next step?

Eating nose to tail requires a shift in mindset and dietary patterns. Offal from intensively reared animals is not a healthy option given the levels of antibiotic usage, over-feeding, excess omega 6 from grain feeding which causes inflammation and the high production of stress hormones. Sourcing offal from grass-fed and ideally, organic animals, means forming direct relationships with our local butchers to understand where animals are raised, how they are fed and where they are slaughtered?

I am coming at this from the point of research, but also because I want to make this part of my weekly diet for myself and my family. Luckily, in Cardiff I have Riverside Community Market which stocks a range of offal and bones on request, and a fantastic family-run butchers in Canton, Oriel Jones, whose premium free range meats are supplied by both their farm in Carmarthenshire and other ethically approved farming partners. Oriel Jones’ proprietor and front of house is Shaun, who is a passionate advocate for animal welfare, the environment and creating a nutritious product.

Nose to tail eating has become one of our hot topics to discuss and it’s heartening to hear that their own faggots and liver pate may soon be available, along with liver, heart, kidney, oxtail and marrow bones. In turn, I love to share my knowledge from a nutritional approach: how the Inuits prevented scurvy by eating the adrenal glands of an animal, which have a high vitamin C content, or what makes liver the most nutrient-dense food.

There is nothing new of course about eating the whole animal and historically many different cultures integrated it into their diet. Wales has a legacy of nose to tail eating, with recipes which have their roots in working communities and post-war austerity. While finances were largely driving resourcefulness in the kitchen, research from the mid-1930s by Dr Weston A Price had already identified the health benefits from consuming the whole animal. His studies identified traditional cultures untouched by modern refined foods, eating whole plant foods and the whole animal, which had no signs of chronic disease or tooth decay. His analysis showed that traditional diets were significantly higher than modern diets in the fat-soluble vitamins A and D, which are found primarily in animal sources and especially organ meat.

Modern society is characterised by the double burden of too many macronutrients (carbohydrates, fats and protein) and not enough micronutrients (vitamins and minerals). This means “empty calories” which contribute to obesity and a plethora of non-communicable diseases like diabetes, CVD, cancer and osteoporosis. We should certainly eat more whole plant foods and reduce or eliminate processed and refined foods, but it’s important to consider offal. Organ meat, cartilage and bones bring a much improved synergy of amino acids plus a wider vitamin and mineral profile to a meal. Small amounts of both muscle meat and offal, rather than an emphasis of one to the exclusion of the other, gives a good nutritional balance according to epidemiological studies of traditional diets.

We are not accustomed to the sight of organ meats and other forms of offal. The Eatwell Plate highlights lean meats like beef, turkey and chicken as healthy options which provide protein and certain micronutrients, while lowering saturated fats. An optimum amount of meat is defined as 70g per day but if the focus shifted to include offal there would be a net increase in overall nutrient density. The easiest place to start would be liver, which for a percentage of the population may be an important source of vitamin A.

Liver has an incredible range of nutrients such as the B vitamins, specifically B12 and folate, iron, zinc, copper, choline, selenium, and polyunsaturated fatty acids DHA and arachidonic acid. It is a rich source of vitamin A in the form of retinol and has some vitamin D, the actual levels depending on how the animal is raised. Retinol is necessary for healthy vision, fertility, immune health, thyroid function and childhood mortality, and more recent studies show protection against type 2 diabetes and regulation of blood glucose.

Retinol is the animal source of vitamin A. The precursor of vitamin A is also available through fruit and vegetables in the form of carotenoids, with the most abundant being beta-carotene. This must be converted to the active form, retinol, in a process which is controlled by a series of enzymes. And herein lies a problem, because recent studies have identified mutations in the family of BC01 genes which control these enzymes. These genetic impairments are estimated to affect 45% of the population, making it difficult for them to convert beta-carotene to retinol. This may be one reason why certain individuals thrive on a vegan or vegetarian diet and others simply don’t.

If two portions a week of meat were replaced with 50-100g of liver, it would supply the RDA for vitamin A, and many other nutrients. This is dependent on age, sex and individual requirements like pregnancy and breast feeding. Therefore, it demonstrates how we can consider liver within the parameters of a sustainable diet which sits comfortably within dietary guidelines.

Liver can be part of a model for sustainable eating in Wales through simple meals like liver and mash, or faggots and onion gravy. It can also be incorporated into family meals like shepherd’s pie and Bolognese sauce. I’ve found I can add approximately 200g of lamb’s liver to either recipe without my children detecting it.

Eating nose to tail is also good for reducing food waste. Here in Cardiff, thanks to the work of Lia Moutselou and Rebecca Clark, the Wasteless Supper pop-up restaurant has collaborated with local businesses to showcase sustainable eating practices such as nose-to-tail eating. Trotters, tails and tongues are still a rare sight in most high street restaurants and this is part of the challenge, along with the need for new culinary skills. Slow cooking is one of the best ways to make the most of cheap cuts and offal. One of my successes to date has been slow cooked, curried sheep’s heart but like all new ventures there have been a few failures along the way.

Nose to tail eating needs more study. It’s an area where research is lacking as most dietary models have not included offal, being largely based on muscle meat. This is something we really need to acknowledge in the backlash against meat. Offal is an important part of a sustainable diet.

Eilish Blade is a qualified Naturopath and practitioner in various types of bodywork based in Cardiff. Currently she is studying a MSc in Nutritional Therapy at Worcester university. She also has a BA in Green Studies with a background in both horticulture and permaculture.