The Effects of Nutritional Therapy on COVID-19 Patients

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The Effects of Nutritional Therapy on COVID-19 Patients
Abstract

COVID-19 patients experience a wide range of symptoms, some of which mimic traumatic brain injuries. Patients who experience changes to the brain that mimic traumatic brain injuries often have trouble focusing, comprehension concerns, or memory loss. “Many of the changes in behavior seen in COVID long-haulers also mirror those from traumatic brain injuries incurred in a car crash, a concussion from a contact sport like football or rugby, or from wartime military service” (Guynup, 2022). 

Nutrition is a crucial component of patient recovery (Tappenden et al., 2013) . According to Koithan (2011), nutritional therapy refers to specific dietary plans designed to deliver nutrients based on specific medical conditions. According to Koithan (2011), “Nutritional Therapy is also concerned with the way that foods are prepared and delivered for consumption. In order for foods to be therapeutically beneficial, the appropriate micro- and macronutrients must be delivered in a nutritionally dense format without contaminants…fruits and vegetables picked before their peak ripeness contain fewer phytochemicals.” However, the benefits of nutrition on COVID-19 patients are not well known due to the novelty of the disease. According to Journal of Clinical Medicine researcher Alfredo Fernández-Quintela (et al., 2020), the role of nutritional support is still undergoing review. “Optimal intake of all nutrients, mainly those playing crucial roles in [the] immune system, should be assured through a diverse and well-balanced diet. Nevertheless, due to the novelty of the disease, information regarding the effects of some nutrients is scarce, and in some cases, this information comes from ecological studies.” (Fernández-Quintela et al., 2020). 

While the role of nutritional choices in COVID-19 recovery has not been studied extensively, traumatic brain injury patients have experienced benefits from nutritional therapy. COVID-19 patients who experience symptoms of TBI may benefit from similar nutritional therapy during recovery to support the healing process. The National Center for Biotechnology Information (NCBI) recommends nutrition for treating traumatic brain injuries (TBI). According to the NCBI (2011), “there is increasing information indicating that nutrition affects brain function and that nutritional strategies may improve resilience or support treatment of brain disorders.” 

Terminology: COVID-19, Traumatic Brain Injury (TBI), Alzheimer's Disease (AD), Medical Nutritional Therapy (MNT). Malnutrition Universal Screen Tool (MUST), Oral Nutritional Supplements (ONS), Alzheimer’s Disease (AD)

Hypothesis

COVID-19 not only causes behavioral changes, but causes symptoms that may be treatable with nutritional therapy. Based on the role of nutrition in helping patients recover from other diseases that result in similar neurological damage, nutritional therapy may be a viable recovery option for patients. Dietary changes for patients experiencing inflammation from Alzheimer’s disease have been prescribed to treat inflammation in patients who have been diagnosed and as a preventative measure. According to the National Institute on Aging (n.d.), dietary changes can be used to mitigate risk factors for Alzheimer’s disease and diets can reduce the risk of contracting a disease that results in cognitive decline. 












Background

COVID-19 has repercussions on brain health that mimic effects of AD and TBI. The symptoms are attributed to inflammation, capillary restriction, and immune responses that attack the body. According to NYU Langone Health (2022), patients hospitalized with COVID-19 had higher levels of proteins in blood samples that indicated neurological damage. According to the National Geographic reporter Sharon Guynup (2022), the damage caused to brain matter from COVID-19 can alter cognitive processes in ways that match Alzheimer’s and Parkinson’s effects. “Many of the changes in behavior seen in COVID long-haulers also mirror those from traumatic brain injuries incurred in a car crash, a concussion from a contact sport like football or rugby, or from wartime military service” (Guynup, 2022). COVID-19 patients experience these symptoms without the “ bump, blow, jolt, or explosive blast to the head, or a penetrating head injury that disrupts the brain’s normal function” (FDA, n.d.) that is associated with TBI.

Nutritional therapy can improve the symptoms of TBI. “Nutrition therapy is one of the most important treatments for traumatic brain injury patients. Not only can it minimize damage to the brain, but the right nutrition program can even help you improve your cognitive and motor function” (Flint Rehab, 2020). Patients experience benefits from nutritional therapy for TBI when therapy is started early and symptoms are new. “In the presence of an acute catabolic state and other common pathophysiologic features of severe brain injury, it is mandatory to avoid delays in starting nutrition therapy to preserve, as much as possible, the skeletal muscle mass, vital organ function, and cerebral metabolic homeostasis” (Kurtz and Rocha, 2020).

In addition to addressing symptoms that mimic TBI in COVID-19 patients, nutritional therapy is already a crucial component of the recovery process for COVID-19 patients due to the prevalence of malnutrition among patients affected by the virus. Malnutrition is a serious concern among populations hospitalized with COVID-19. A Malnutrition Universal Screen Tool (MUST) determined that 23 of 50 patients with COVID-19 in the San Raffaele Scientific Institute in Milan, Italy had a high risk of malnutrition (Brugliera et al., 2020). According to Brugliera et al., (2020), “the prevention, diagnosis, and treatment of malnutrition must be regularly included in the management of hospitalized COVID-19 patients in a rehabilitation department, to improve both short and long-term prognosis [9, 10].” Malnutrition slows the healing process for COVID-19 patients and “ demonstrated that malnutrition delays healing times and increases hospitalization periods” (Brugliera et al., 2020). According to Brugliera et al. (2020), the risk of malnutrition is increased by outstanding conditions in COVID-19 patients: “The risk of malnutrition of COVID-19 patients is related to chronic pathologies and the reduction of food intake caused by nausea, diarrhea, and the loss of appetite. The most common chronic conditions observed in COVID-19 patients are diabetes, chronic obstructive pulmonary disease, renal insufficiency, cardiovascular diseases, and dementia” (Brugliera et al., 2020). Increased age is associated with malnutrition due to lifestyle and physiological changes, making nutritional support a priority among older populations (Amarya et al., 2015).

Methods

Reviewing previous nutritional therapy techniques for patients who suffer from traumatic brain injuries (TBI) similar to the TBI symptoms experienced by COVID-19 patients. Reviewing medical advice from professionals about the different nutritional therapy techniques used to alleviate or manage COVID-19 symptoms.

Results

While there are similarities between the diets for AD, TBI, and COVID-19, the physical presentations of the conditions make each therapeutic approach unique. The common factor among diets for all three conditions is protein. Nutritional therapy is used to manage inflammation in both AD patients and COVID-19 patients: “almost all patients present at the time of hospitalization had a severe inflammatory status and anorexia, which led to a strong reduction in food intake. Authors provided a rapid intravenous administration of whey proteins, vitamins, and minerals (and cholecalciferol if insufficient) up to the achievement of the recommended dietary allowance” (Brugliera et al., 2020). In addition, both TBI patients and COVID-19 patients require a diet high in fat and protein (Flint Rehab, 2020). 

However, the role of nutrition for COVID-19 recovery varies depending on the existing conditions patients have. For example, patients with COVID-19 and diabetes have insulin concerns that COVID-19 patients without diabetes do not have (Mayo Clinic Staff, 2022). Patients with TBI also have intracranial pressure changes that affect the fluids patients receive and the nutritional therapy the patients are prescribed: “TBI patients usually receive either osmotic diuretics or hyperosmolar fluids, such as hypertonic saline, for the treatment of increased intracranial pressure (ICP). This adds to the challenge of clinicians to prevent increased fluid and electrolyte derangements, which are also common after neurologic injury. Thus, nutrition therapies should consider precise fluid resuscitation strategies, with special attention to strict electrolyte monitoring, specific to TBI patients, with the purpose of avoiding excessive fluid, electrolyte, and glucose shifts that could be detrimental to these patients” (Kurtz & Rocha, 2020). According to Kurtz & Rocha (2020), the glucose shifts patients experience can also require physicians to monitor insulin and to have nutritional therapy that helps stabilize insulin levels and address glucose changes. This is not a concern for all COVID-19 patients. While some COVID-19 patients with diabetes will need diets that address glucose and insulin shifts, COVID-19 patients with other conditions will need nutritional therapy tailored to different conditions. If patients are unable to consume protein, diets are adjusted accordingly:“For those unable to eat, high proteins and enteral/parenteral nutrition (PN) formulas with low glucose content, according to recent ESPEN guidelines on clinical nutrition in the intensive care unit, are warranted [7].”

Conclusion

Patients receiving nutritional therapy for COVID-19 do benefit from aspects of nutritional therapy for TBI and AD. Diets for TBI, AD, and COVID-19 prioritize protein and vitamin supplement plans specific to patient needs. However, AD diets also prioritize omega-3 and fatty acids in addition to protein and vitamins as needed: “ a Mediterranean diet rich in antioxidants, fiber and omega-3 polyunsaturated fatty acids may have a protective effect on the neurodegenerative process” (Śliwińska and Jeziorek, 2021). However, according to Śliwińska and Jeziorek (2021) diets for AD are designed to stop the progression of the disease and reduce inflammation which improves a patient’s wellbeing whereas COVID-19 patients receive nutritional therapy to stop progression and reverse symptoms. Vascular inflammation affects cognitive function in COVID-19 patients (Christensen & Berg, 2021). Nutritional therapy improves cranial vascular function by reducing inflammation. However, reducing inflammation is not the only aspect of treating patients with COVID-19. Nutrient deficiencies, outstanding conditions, medical history, age, and the unique way COVID-19 affects different patients informs nutritional therapy approaches prescribed.

Further Research: Preventative Care

Populations at risk of developing severe cases of COVID-19 may be able to adopt dietary changes as a preventative measure against severe COVID-19 infections. Patients who are experiencing cognitive decline may see improvements in cognitive function after adopting diets recommended for Alzheimer’s patients who experience similar cognitive symptoms.

Preventative care for COVID-19 could be conducted with focus groups of high-risk individuals willing to make dietary changes to reduce the risk of developing severe COVID-19. The relationship between diet and COVID-19 could also be explored by speaking with health professionals who have seen improvements in patients who consume certain types of foods during COVID-19 recovery.

In addition, some COVID-19 patients are left with physical changes to the brain that mimic changes associated with AD (Hamilton, 2021). Further research will determine whether or not patients with COVID-19 symptoms that result in these changes will benefit from diets related to reducing inflammation for AD patients. 

Resources

Amarya, S., Singh, K., Sabharwal, M. (September 2015). Changes during aging and their association with malnutrition. Journal of Clinical Gerontology and Geriatrics. Retrieved on May 2, 2022 from https://www.sciencedirect.com/science/article/pii/S2210833515000672#:~:text=Diminished%20senses%20of%20taste%20and,a%20consequence%20of%20ill%20health. 

Brugliera, L., Castellazzi, P., Cimino, P., Negro, A., Houdayer, E., Alemanno, F., Giordani, A., & Iannaccone, S. (May 20, 2020) Nutritional management of COVID-19 patients in a rehabilitation unit. European Journal of Clinical Nutrition. Retrieved on May 1, 2022 from https://www.nature.com/articles/s41430-020-0664-x 

Christensen, R., Berg, Ronan. (March 19, 2021). Vascular Inflammation as a Therapeutic Target in COVID-19 “Long Haulers”: HIITing the Spot?. Retrieved on May 1, 2022 from https://www.frontiersin.org/articles/10.3389/fcvm.2021.643626/full 

FDA. (n.d.) Traumatic Brain Injury: What to Know About Symptoms, Diagnosis, and Treatment. Retrieved on April 10, 2022 from https://www.fda.gov/consumers/consumer-updates/traumatic-brain-injury-what-know-about-symptoms-diagnosis-and-treatment 

Fernández-Quintela, A., Milton-Laskibar, I., Trepiana, J., Gómez-Zorita, S., Kajarabille, N., Léniz, A., González, M., & Portillo, M. (2020). Key Aspects in Nutritional Management of COVID-19 Patients. Journal of Clinical Medicine & NCBI. Retrieved on March 13, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463687/ 

Flint Rehab. (October 15, 2020). How Nutrition Therapy for Traumatic Brain Injury Can Help the Brain Heal. Retrieved on March 13, 2022 from https://www.flintrehab.com/nutrition-therapy-for-traumatic-brain-injury/#:~:text=Nutrition%20therapy%20is%20one%20of,your%20cognitive%20and%20motor%20function.

Guynup, Sharon. (December, 2021). Can COVID-19 alter your personality? Here's what brain research shows. National Geographic. Retrieved on March 13, 2022 from https://www.nationalgeographic.com/science/article/can-covid-19-alter-your-personality-heres-what-brain-research-shows

Hamilton, Jon. (July 26, 2021). Doctors Worry That Memory Problems After COVID-19 May Set The Stage For Alzheimer's. Retrieved on May 1, 2022 from https://www.npr.org/sections/health-shots/2021/07/26/1019875347/doctors-worry-that-memory-problems-after-covid-19-may-set-stage-for-alzheimers 

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