By Maureen Nabatanzi
Uganda confirmed her first case of the Coronavirus Disease (COVID-19) on 21 March 2020. By 11 May, barely two months later, the number of confirmed cases had increased to 121. With the steady increase in national and global number of cases, treatments are desperately needed. People are looking for solutions and some members of the public are using this as an opportunity to market nutritional and herbal products and therapies.
Misleading marketing of nutritional and herbal products that claim to prevent, treat, and cure the disease can negatively affect the public’s dietary decisions and in turn their health. This misinformation may also distract people from effective preventive measures including: observing hand hygiene, social distancing, coughing etiquette, and prompt notification of persons with signs and symptoms to health officials for appropriate management.
So what can diet do?
During Uganda’s presidential address on COVID-19 held on 18 March 2020, the Minister of Health, Dr. Jane Ruth Aceng advised the public to eat lots of fruits and vegetables and to remain hydrated by drinking at least three liters of water per day. “Do not miss your meals, we want to encourage people to be frequent with their meals (so that just in case the virus strikes, it finds a healthy victim)," she added. She also urged people to maintain food hygiene.
The wealth of scientific evidence agrees that eating a balanced diet in the right proportions is essential for one to meet their body’s nutritional requirements, prevent malnutrition and be healthy. In addition, a diet rich in micronutrients (vitamins and minerals) maintains a healthy immune system, which helps us ward off infections. A diet high in saturated fats (e.g. animal fats like ghee), sugar, and salt, especially when coupled with lifestyle behaviours like excessive alcohol consumption, smoking and limited physical exercise, can increase the risk of noncommunicable diseases (NCDs). This is vital because the presence and number of comorbidities especially NCDs like hypertension, diabetes, and coronary heart disease is associated with poorer clinical outcomes in patients with COVID-19. Obesity is also closely linked to higher risk of severe forms of COVID-19.
A balanced diet is recommended
The specific foods in a diversified, balanced and healthy diet may vary depending on individual characteristics like age, gender, lifestyle, cultural context, locally available foods and dietary customs. Below is a description of a Ugandan balanced diet that is based on the World Health Organization (WHO)’s recommendation:
- Fruits (e.g. pineapples, mangoes, bananas and citrus fruits) and vegetables (e.g. green leafy vegetables like nakati, green and red peppers, onions, carrots, tomatoes, beetroot, eggplants and moringa). These contain a variety of micronutrients such as antioxidants, vitamins like C and A, and minerals like Iron. Antioxidants support immune response.
- Legumes (e.g. peas and beans), nuts (simsim) are body building plant proteins. Grains (e.g. maize, rice, millet and sorghum) and starchy foods (e.g. potatoes, sweet potatoes and cassava) are important sources of energy.
- Less than 10% (50g or about 12 level teaspoons) of total energy intake should come from foods high in free sugars (found in sugar, honey, syrups, fruit juices and fruit juice concentrates).
- Less than 30% of total energy intake should come from fats. Unsaturated fats (found in fish, avocado and nuts, and in sunflower) are preferable to saturated fats (found in fatty meat, coconut oil, cream, cheese, and ghee). Similarly, limit trans-fats of all kinds (found in baked and fried foods, such as potato chips, biscuits, cooking oils and margarine).
- Proteins from animals and their products are essential body builders. Choose lean (low-fat) meats and poultry to limit cholesterol intake. Milk and yoghurt are rich sources of calcium, phosphorous and vitamins B12 and B2. Increase fish consumption (rich source of omega-3 fatty acids) to reduce the risk of heart disease. Meat, poultry, fish and eggs are good sources of selenium, an antioxidant that supports immune response.
- Less than 5g of iodized salt (equivalent to about one teaspoon) per day. Adequate water consumption prevents dehydration and contributes to body functions. Viral infections associated with fever can be dehydrating.
- For infants and young children, exclusively breastfeed during the first 6 months of life. At 6 months, introduce safe and nutrient-dense foods in addition to breastfeeding, and continue breastfeeding until 2 years of age and beyond.
Physical activity remains important
Being active not only helps you maintain a healthy body weight and reduce your risk of NCDs, it can be good for morale. Despite the social restrictions brought on by the COVID-19 outbreak, you can still do activities like skipping rope, exercises around a room or utilizing online workout videos.
Additional care during COVID-19 infection
For infected persons, WHO recommends feeding within 24–48 hours of admission to reduce incidence of stress ulcers and stomach/intestinal bleeding. Feeding can include a normal oral diet, the use of liquid supplements or delivery by use of a tube (tube feeding). The diet should meet the nutrient needs as described above. Uganda’s clinical management guidelines for COVID-19 recommend use of Vitamin C and Zinc as supportive (adjunctive) treatments or therapies.
For infants and young children, breastfeeding has a strong immune protective effect. Infectious diseases are prevented through direct transfer of mother’s antibodies and other anti-infective compounds. Based on current scientific research in China, COVID-19 is not transmitted to children during pregnancy or breastfeeding. Infants born to mothers with suspected, probable, or confirmed COVID-19 should be fed according to the above standard guidelines while applying necessary precautions. Precautions include: washing hands with soap and water before and after feeding or contact with infant, routinely cleaning surfaces with soap and water, and use of a face mask if the mother has respiratory symptoms like cough and flu.
Making informed dietary decisions
A balanced diet composed of natural foods is the best source of nutrients for a healthy body. Although some dietary supplements can help support healthy immune function, the decision whether to take one should be discussed with your nutritionist or doctor. No supplement may claim to diagnose, prevent, treat or cure COVID-19.
The writer is an Epidemiology Fellow on the Uganda Public Health Fellowship Program; a partnership between the Ministry of Health, Makerere University School of Public Health and the US CDC.