Coronavirus Action Plan

The Effects of Insulin and Short Chain Fatty Acids on Immune Cells and Inflammation

Coronavirus is the overwhelming public health concern at the present time. So, what can we do from a lifestyle/nutrition perspective to prevent severe reactions? What distinguishes those who respond badly to the infection to the majority who just suffer typical symptoms of a bad flu.

Although it is likely that the amount of virus replicating in our cells is important to the severity of symptoms it is the exaggerated inflammatory response that causes most damage and is potentially lethal through toxic shock and widespread blood clotting inside the body (Disseminated Intravascular Coagulation DIC) triggered by a “cytokine storm” similar to “sepsis”, which can occur with influenza virus and other viral and bacterial infections.

Nobody knows for sure but these hypotheses and speculations that are worth considering.

The mortality rate is 10 times higher in those with diabetes, hypertension, obesity, and heart disease. All these conditions are associated with a pro-inflammatory state. In obesity, metabolic syndrome and T2Diabetes fat cells are infiltrated with inflammatory macrophages (M1 macrophages). At the same time that insulin resistance promotes M1’s, high insulin levels suppress vitally important anti-inflammatory cells (Tregs) and we all know eating refined carbs massively spikes insulin levels. The majority of our immune cells reside in and around the gut where Treg cells are produced in response to increased levels of short chain fatty acids and you only get significant amounts of SCFAs by fermentation of fibre in the hind gut.

The short chain fatty acid butyrate is a powerful histone deacetylase inhibitor that promotes Treg transformation. Butyrate also increases production of the anti-inflammatory cytokine IL-10 in Breg cells. Conversely, high blood glucose and diabetes prevents production of the anti-inflammatory cytokine IL-10. A natural approach to prevention is essential as there is already a reluctance to employ drugs for HDAC inhibition for fear of going too far and suppressing immunity against infections and cancer. In reality, the only available practical tool to help prevent autoimmune and inflammatory disorders is a low carb, high prebiotic fibre diet.

Further benefits of high fibre consumption are to be expected due to hydrogen gas (H2), which is another by product of fibre fermentation and H2 has proven anti-inflammatory effects as well. In fact, Chinese doctors are already using inhalation of 2-4% H2 gas along with oxygen for the treatment of respiratory distress due to COVID-19 apparently with dramatic success. Other doctors in Japan are recommending a glucosidase inhibitor (Acarbose) to increase H2 levels from fermentation of undigested carbohydrate to suppress inflammation. But the most effective way to supply vast amounts of H2 to all parts of the body are through colonic fibre fermentation. The example below shows prolonged H2 production from 15 g of lactose from milk functioning as a prebiotic.

Intermittent Fasting

One more lifestyle modification to consider is time restricted feeding or intermittent fasting. The easiest way to do this IMO is skipping breakfast and having one meal a day (OMAD) but going as long as you can into the afternoon or evening before eating is all you need to do. The benefits to immunity, health and aging are well documented. The inflammatory cytokines (IL-6, TNFa) are reduced and the phagocytic capacity of immune cells is enhanced. By the way fasting is a lot easier to stick to when you have a fibre in your hind gut producing SCFAs and satiety hormones (GLP1 & PYY).

Which anti-inflammatory drugs should we use?

The common non-steroidal anti-inflammatory drugs (NSAID) available are aspirin and ibuprofen. There is some concern about ibuprofen as it increases the ACE2 receptors on cells and the coronavirus enters cells after binding to ACE2 receptors on the cell surface. In response to the outbreak there has been a huge run on ibuprofen stocks all around the world but I’m not recommending it. Most authorities are recommending paracetamol for symptom relief but paracetamol has very little anti-inflammatory effects.

The better choice would be aspirin because it also prevents platelet activation which is an important deterioration in the disease process and leads to DIC (clotting inside blood vessels). In fact mortality from coronavirus is rare in the absence of DIC. Rheumatic fever was common in the 50's and aspirin was used in high doses to prevent the auto-inflammatory complications of rheumatic fever, in fact it is still the main anti-inflammatory drug used in this disease and has been found to be the best NSAID to prevent DIC in sepsis. There are trials ongoing on the possible protective effect of aspirin of COVID.

Might be worth considering Indomethacin, a prescription only NSAID that has been shown to suppress coronavirus replication in a study from Italy in 2006.

Bottom Line

1. 1. Start a low carb high fibre diet so you don't get hungry and can fast for 14-16 hours a day.

2. Stock up on aspirin. Cheap and available over the counter.

3. 2. As soon as aches, sore throat, diarrhea and cough appear take high doses of aspirin.

Figure from Science Magazine: Feed Your Tregs More Fiber, Julia Bollrath and Fiona Powrie