As schools reopen, children and parents are gradually returning to their routines, but it's crucial to ensure our children are equipped to maintain their health and well-being. In this article, we'll explore how proper nutrition and practical tips can bolster your children's immune systems and contribute to their overall well-being.

1. Prioritize Basic Protective Measures

Before sending your children to school, instill in them the importance of basic protective measures:

• Hand Hygiene: Remind your children to wash their hands thoroughly with soap and water or use an alcohol-based hand sanitizer. However, emphasize that they should wash their hands before eating instead of using sanitizer.

• Respiratory Etiquette: Teach your children to cover their mouth and nose with their bent elbow when coughing or sneezing. Encourage them to dispose of used tissues immediately and avoid touching their eyes, nose, and mouth.

• Social Distancing: Emphasize the significance of maintaining a safe distance of at least 1 meter from anyone who is coughing or sneezing.

2. Encourage Proper Hydration

Ensure your children stay hydrated throughout the day by:

• Providing Water: Encourage your children to bring plain water to school. Water is the healthiest choice and helps maintain their overall health.

• Incorporate Hydrating Foods: Apart from water, include foods with high water content in their diet, such as cucumber, tomatoes, spinach, and melon. Avoid sugary drinks like fruit juices, syrups, and fizzy beverages.

Constipation is common among children. As parents, you may notice that your child has constipation if:

• They have not pooped in at least three days.

• Their poop is large and hard; it looks like rabbit droppings or little pellets.

• They are straining or in pain when they poop.

• They may have some bleeding during or after pooping because their poop is hard.

Another sign to look for is when a child has a poor appetite or stomach pain that improves after they poop. Soiled pants are one of the symptoms of constipation in children aged one and up, as runny poop may leak around the hard constipated poop. This is called overflow soiling.

Constipation is common in toddlers aged 2 to 3 years old, according to health professionals. This is because usually at this age, parents start to potty train their children, which makes them feel uneasy about the whole poop situation.

Here are some tips that you may try to prevent your child from experiencing constipation or to help them while they are constipated.

• Make sure they drink plenty of fluid. Most of the time, children are unable to tell you if they are thirsty, especially if they are merely 1 year old. One of the tips that we can practice is to always make sure their sippy cup is full and within their reach so that it will be easier for them to drink water whenever they want. Sometimes children are so occupied with playing that they do not drink water, so it is best to remind them every few hours to drink water. 

• Consume a high-fiber diet. This means to load your child's plate with plenty of fresh fruits and vegetables, high-fiber cereals, whole-grain breads (look for at least 3-5g of fiber per serving), and a variety of beans and legumes, such as lentils and chickpeas. One of the good sources of fiber that children love most is popcorn (but prepare it with the minimum amount of sugar, butter, and salt). You may also let them prepare their own popcorn or fruit salad; this will even stimulate their appetite, and of course they will learn and enjoy the process. Foods containing probiotics, such as yogurt, can also promote good digestive health.

• Doing a lot more physical activity. Sedentism can also be detrimental to bowel movements. Children under the age of five require at least three hours of physical activity per day. So, let them move around, let them jump and climb, but keep in mind that all of this must be monitored and done in a safe environment, especially for young toddlers.

• Regular toilet time. This is especially true for children who are undergoing toilet training. Encourage your child to use the toilet first thing in the morning and after every meal or snack. Set a timer for every 30 to 45 minutes to take them to the bathroom. Instead of suggesting, "Do you need to go to the bathroom?" simply say, "Time to go to the bathroom now." Having regular toilet time also means helping them have regular time for everything else, such as their mealtimes and their naps. This will also help them easily adapt to this new habit of going to the toilet whenever they feel the urge.

• Stool softener to clear the bowels. These are safe for children, but they need to be used under the supervision of a doctor or pharmacist. A common mistake when it comes to using stool softener is that parents tend to stop using it after their child has their first normal-looking bowel movement, but stopping too soon may just set your child up for another episode of constipation. So, what you can do is talk to your doctor; it is okay to let your child stay on stool softener for a few weeks. At the same time, try your best to cultivate lifestyle and dietary changes that can improve your child's bowel movements.

In conclusion, always try to monitor your child's bowel movements so you may notice any changes, especially if they are under 2 years old, as they cannot verbally tell what is going on in their body or if they are in pain. Noticing it early will allow you to better prepare to assist them in relieving their bowel condition than if it is already chronic. Also, if it has been too long already or if your child is in pain whenever you press their abdomen (to this extent), it is best to seek advice from a doctor regarding your child's condition.

References.

1. National Health Service (NHS) U.K. Constipation in children. https://www.nhs.uk/conditions/baby/health/constipation-in-children/ (Accessed on April 1, 2021).

2. National Institute of Diabetes, Digestive and Kidney Disease (NIDDK). U.S Department of Health and Human Services. Symptoms and Causes of Constipation in Children. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation-children/symptoms-causes (Accessed on April 1, 2021).

3. Mayo Clinic. Constipation in Children. https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242#:~:text=Constipation%20in%20children%20is%20a,constipation%20in%20children%20are%20temporary. (Accessed on April 1, 2021).

Lignosus rhinoceros, or its common name, Tiger Milk Mushroom, has been used since ancient times. It is very precious due to its rarity, since it grows in isolation. Within the same 5km radius, you will not find another stalk of Tiger Milk Mushroom. Another reason is that the medicinal properties of Tiger Milk Mushroom are only found in the underground tuber; if you find it at the stage where it has already sprouted out from the ground with a stem and cap, the active compound inside it may have already diminished. Tiger Milk Mushroom, also known as ‘Cendawan Susu Harimau, got famous after the former Prime Minister, Tun Dr. Mahathir Mohamad, said his chronic cough stopped after he consumed Chinese medicine derived from Tiger’s Milk Mushroom at the opening of the International Convention on Biotechnology in 2002 in Kuala Lumpur (1, 2).

Frequently, we perform thousands of breaths each day, often without contemplating the significance and benefits this fundamental bodily function affords us. In contrast to the indispensability of breathing, research regarding breathing techniques remains relatively limited. Nevertheless, there are specific breathing techniques recommended for enhancing various aspects of our health.

Stress and Belly Breathing

One of the most common techniques is breathing exercises aimed at managing stress. Numerous studies have conclusively demonstrated the efficacy of breathing exercises in alleviating anxiety disorders, panic attacks, and general stress. The United Kingdom's National Health Service (NHS) recommends the use of belly breathing for individuals grappling with stress, anxiety, and panic (1). In today's context, where mental health issues have become increasingly prevalent due to the ongoing COVID-19 pandemic and other stressors, it's crucial to educate ourselves and our loved ones on how to respond when confronted with situations that trigger panic, anxiety, or stress (2).

The lungs are a pair of organs in your chest. When you inhale (breathe in), air enters your lungs, and oxygen from the air moves from the lungs to the blood. At the same time, carbon dioxide (a waste gas) moves from the blood to the lung and is exhaled (breathed out). This whole process is known as gas exchange. It is essential to life, despite the very short microsecond period that it takes to complete the cycle (1).

Apart from the lung, the brain also plays a vital role in this whole system. The brain is the one that controls your breathing rate (how fast or slowly you breathe) by sensing your body’s need for oxygen and its need to get rid of carbon dioxide (1).

Exercise and breathing

Exercise is vital to maintaining a healthy body. The benefits of exercise include the well-being of your physical and mental health. As for physical health, studies found that exercise is not only good for individuals with chronic diseases such as obesity, diabetes, hypertension, and many others, but it is also good for lung health (2, 3).

During exercise, the lungs bring oxygen into the body to provide energy and, at the same time, remove carbon dioxide. while the heart pumps oxygen to the muscles that are exercising (2).

When you exercise, your muscles work harder, and your body uses more oxygen and produces more carbon dioxide. To cope with this extra demand, your breathing has to increase from about 15 times a minute (12 litres of air) when you are resting to about 40–60 times a minute (100 litres of air) during exercise. Your circulation also speeds up to take oxygen to the muscles so that they can keep moving (2).

When your lungs are healthy, you have a large breathing reserve. You may feel ‘out of breath’ after exercise, but you will not be ‘short of breath’. When you have reduced lung function, you may use a large part of your breathing reserve. This may make you feel ‘out of breath’, which can be an unpleasant feeling, but it is not generally dangerous (2).

In fact, all these processes, if practised regularly, will improve lung health. How? By improving lung capacity. Even for people with lung problems such as chronic obstructive pulmonary disorder (COPD), it is also recommended to exercise frequently and to practise breathing techniques that can help with them, such as the diaphragmatic breathing technique (3, 4).

Cordyceps is a genus of parasitic fungi that grows on the larvae of insects. When these fungi attack their host, they replace its tissue with long sprouts and slender stems that grow outside the host’s body. The remains of the insects and fungi have been hand-collected, dried, and used in Traditional Chinese Medicine for centuries to treat fatigue, sickness, kidney disease, and low sexual drive (3).

Since there is now an increased shift of attention from synthetic drugs to natural herbal products, not only to treat the common cold and flu but also to prevent chronic diseases, people start to consume various kinds of traditional medicine in an effort to prevent or control diseases (2).

Since cordyceps live only on certain caterpillars in the high mountain regions of China, natural cordyceps are hard to get and are expansive. Most supplements are made with cordyceps grown in the laboratory, which is also known as Cordyceps CS-4. People start to market products containing cordyceps in supplement form or as functional foods since many studies start to dig into their benefits. From more than 400 species of cordyceps discovered, only two types of cordyceps are commonly used, which are Cordyceps sinensis and Cordyceps militaris (3).

Traditionally, people used cordyceps for various purposes; until now, certain people who were able to get wild cordyceps still used this in their daily lives. Some people mix it with milk; it is said to improve sexual drive. It is also sometimes mixed with alcohol, which is referred to as ‘chang', in which people drink it in the morning as tonic (5).

As for modern studies, apart from the usage of cordyceps in cough syrup, cordyceps also have various other health benefits, such as antihyperglycemic. A study on diabetic rats found that the 4g/kg/day that is administered to diabetic rats does not affect their fasting insulin level. When oral administration of cordyceps at 150 mg/kg/day and 500mg/kg/day is ingested by mice for 4 weeks, it significantly prolongs the swimming time of mice by about 20 to 24 minutes, respectively, thus showing that consumption of cordyceps also improves fatigue conditions. It is the involvement of cordyceps in adenosine triphosphate (ATP) (energy) production that accounts for a decrease in physical fatigue when it is administered. Apart from that, the administration of cordyceps decreased the airway inflammation in ovalbumin-induced mice, thus easing breathing for individuals with cough and flu (6).

However, most studies with regards to cordyceps are conducted on mice, not humans, so the findings are considered to have insufficient evidence (1, 3, 4).

However, it is safe to consume cordyceps supplements with other medications if you have any other medical condition since the government of China uses cordyceps as a natural drug in their hospitals to treat patients (1, 3, 4).

References

Foods are supposed to be the best source of nutrients readily available to be absorbed by the body; unfortunately, with our current advancement of food technology, it does not only make our food less perishable, which is a good thing, but it also, through the process, makes it lose the vital nutrients inside the food. Not only that, the advancement in the culinary field makes our taste buds somehow lose its palatability towards healthy food. During the hunting and gathering time, our senses used to tell us what was good or not through smelling and the taste of it (whether it was rotten or dangerous to be consumed), but nowadays people seem to be losing all those. We are only able to tell based on the looks of the food; if it has lots of greens, then it must not be good, but if it has lots of chocolate or cheesy things on it, then it must be tasty. Especially in Malaysia, that is what seems to happen.

The World Health Organisation (WHO) defines probiotics as live microorganisms that, when administered in adequate amounts, confer health benefits on the host. It can be found in fermented foods (e.g., yoghurt, kefir, sauerkraut, tempeh, and kimchi), dietary supplements, and cosmetics.

Probiotics can contain a wide range of microorganisms. Lactobacillus and Bifidobacterium are the most common. Other bacteria, such as Saccharomyces boulardii, are also used as probiotics.

According to research, different types of bacteria have different effects on the human body. As a result, selecting the right strains and types of probiotics is critical for it to work on the said health concern.

How do probiotics aid in health maintenance?

There are a variety of ‘bugs’ that coexist naturally in the body, such as bacteria, fungi, parasites, and viruses; these are what scientists refer to as the microbiome. In the body of a healthy person, all these bugs coexist peacefully. The role of the microbiome is to promote the smooth daily operation of the human body. However, conditions such as infectious illness, a certain diet, and prolonged use of antibiotics and/or other bacteria-destroying medications can make the body more susceptible to diseases.

Due to this, scientists believe that consumption of probiotics influences the colonisation process of bacteria, which can lead to a speedy restoration of a healthy microbiome and a lower risk of getting sick.

Probiotics and COVID-19

Probiotics are linked with COVID-19 due to their ability to boost the immune system. Currently, the most extensive research on probiotics includes Lactobacillus, Bifidobacterium, Escherichia coli, Enterococcus, etc. Although probiotics mechanisms profoundly focus on the gastrointestinal tract, their effects are not confined to the digestive system alone. Probiotics can act on the entire body via immune modulation. Not only that, it also facilitates the immune system's development and maturation and regulates the interaction between host and pathogen by killing the pathogen and regulating the immune responses towards it.

One could argue that, but COVID-19 is a viral infection, not a bacterial infection. A systematic review described the efficacy of probiotics against viral diseases, with over 20 strains of probiotics demonstrating anti-inflammatory effects on the body and antibody production against viruses.

Furthermore, the study discovered that probiotics supplementation reduced viral loads. This is thought to be due to immune modulation by microbiota, which fights COVID-19 directly and reduces the risk of secondary infections caused by prolonged antibiotic exposure from multiple experimental COVID-19 treatments.

China’s National Health Commission recommended probiotics for severe COVID-19 patients to restore the intestinal balance and protect from secondary infections. Moreover, gut microbiota’s role in modulating lung diseases has been demonstrated.

In conclusion, the researchers in this study believe that many more studies on the effectiveness of using probiotics for COVID-19 prevention and treatment should be conducted. Individuals may now benefit from probiotics rich foods and supplementation for its boosting immunity properties and fight against COVID-19, in addition to practising social distancing, wearing masks, and adhering to standard operating procedures (SOP).

Reference

1. Kurian, S. J., Unnikrishnan, M. K., Miraj, S. S., Bagchi, D., Banerjee, M., Reddy, B. S., Rodrigues, G. S., Manu, M. K., Saravu, K., Mukhopadhyay, C., & Rao, M. (2021). Probiotics in Prevention and Treatment of COVID-19: Current Perspective and Future Prospects. Archives of medical research, 52(6), 582–594. https://doi.org/10.1016/j.arcmed.2021.03.002

Colostrum is a type of breast milk produced by mammals, including humans. Before breast milk is released, it is usually thicker in consistency and contains high levels of antibodies. This high concentration of nutrients in the colostrum is aimed at promoting the growth and health of newborn mammals, which is why it is the most nutritious form of milk (1).
 

For humans, the consumption of colostrum by newborns is very much encouraged; apart from the promotion of exclusive breastfeeding up to 6 months and 2 years by the Ministry of Health Malaysia (MOH), mothers are as well encouraged to give skin-to-skin support while breastfeeding newborns for the colostrum few hours after delivery.

The colostrum is said to have various benefits for the newborn as they get older (2).

 What about the adults? Does adult consumption of bovine colostrum have the same effect as mother-to-newborn colostrum?

Bovine colostrum is more nutritious than regular milk. It contains more protein, fat, carbohydrates, magnesium, and vitamins A, C, B, and E than regular milk. Due to this, studies have found that the consumption of bovine colostrum by adults is useful in boosting the immune system as well as improving gut health (1, 3).

The presence of lactoferrin in colostrum contributes to the link between colostrum and immunity. Lactoferin is a protein that occurs naturally in the body. It is a very versatile protein because it is a bi-lobed protein that can bind an iron atom (4). This transferrin-family iron-binding glycoprotein is an important component of the mammalian immune system. As a result, it provides lactoferrin with protective effects ranging from direct antimicrobial to anti-inflammatory and anti-cancer (4).

Apart from this, colostrum also contains antibodies. Antibodies are proteins, also known as immunoglobulins, used by the immune system to fight bacteria and viruses. Bovine colostrum is rich in the antibodies IgA, IgG, and IgM (1, 2). This is also essential for fighting pathogens and improving the immune system.

Since bovine colostrum is loaded with nutrients that fight disease and promote growth, it is able to boost immunity, treat infections, and offer more related benefits to humans throughout their lives. Thus, the consumption of bovine colostrum may have the same effect as human colostrum; it is just that the absorption of colostrum from a bovine to a human body is different, but with all the spectacular ingredients that colostrum possesses, it may possess the same effect as boosting immunity!

References

1. Healthline. What is the colostrum? Nutrition, Benefits and Downsides. https://www.healthline.com/nutrition/bovine-colostrum (Accessed on July 9, 2020).
2. Bloomlife. Breastfeeding Tips To Know Before the Baby Arrives. https://bloomlife.com/pregu/breastfeedingtipscolostrum/#:~:text=Studies%20show%20that%20expressing%20colostrum,in%20her%20first%20few%20days  (Accessed on July 9, 2020).
3. WebMD. Bovine Colostrum. https://www.webmd.com/vitamins/ai/ingredientmono-785/bovinecolostrum (Accessed on July 9, 2020).
4. Bioquad Lifesciences. https://bio-quad.com/blogs/article-1/whatislactoferrin (Accessed on July 9, 2020).

Cordyceps is a genus of parasitic fungi that grows on the larvae of insects. When these fungi attack their host, they replace its tissue with long sprouts and slender stems that grow outside the host’s body. The remains of the insects and fungi have been hand-collected, dried, and used in Traditional Chinese Medicine for centuries to treat fatigue, sickness, kidney disease, and low sexual drive (3).

Since there is now an increased shift of attention from synthetic drugs to natural herbal products, not only to treat the common cold and flu but also to prevent chronic diseases, people start to consume various kinds of traditional medicine in an effort to prevent or control diseases (2).

Since cordyceps live only on certain caterpillars in the high mountain regions of China, natural cordyceps are hard to get and are expansive. Most supplements are made with cordyceps grown in the laboratory, which is also known as Cordyceps CS-4. People start to market products containing cordyceps in supplement form or as functional foods since many studies start to dig into their benefits. From more than 400 species of cordyceps discovered, only two types of cordyceps are commonly used, which are Cordyceps sinensis and Cordyceps militaris (3).

Traditionally, people used cordyceps for various purposes; until now, certain people who were able to get wild cordyceps still used this in their daily lives. Some people mix it with milk; it is said to improve sexual drive. It is also sometimes mixed with alcohol, which is referred to as ‘chang', in which people drink it in the morning as tonic (5).

As for modern studies, apart from the usage of cordyceps in cough syrup, cordyceps also have various other health benefits, such as antihyperglycemic. A study on diabetic rats found that the 4g/kg/day that is administered to diabetic rats does not affect their fasting insulin level. When oral administration of cordyceps at 150 mg/kg/day and 500mg/kg/day is ingested by mice for 4 weeks, it significantly prolongs the swimming time of mice by about 20 to 24 minutes, respectively, thus showing that consumption of cordyceps also improves fatigue conditions. It is the involvement of cordyceps in adenosine triphosphate (ATP) (energy) production that accounts for a decrease in physical fatigue when it is administered. Apart from that, the administration of cordyceps decreased the airway inflammation in ovalbumin-induced mice, thus easing breathing for individuals with cough and flu (6).

However, most studies with regards to cordyceps are conducted on mice, not humans, so the findings are considered to have insufficient evidence (1, 3, 4).

However, it is safe to consume cordyceps supplements with other medications if you have any other medical condition since the government of China uses cordyceps as a natural drug in their hospitals to treat patients (1, 3, 4).

References

1. Mehra A, Zaidi KU, Mani A, Thawani V. The health benefits of Cordyceps militaris a review. Kavaka. 2017;48(1):27-32.

2. Nxumalo W, Elateeq AA, Sun Y. Can Cordyceps cicadae be used as an alternative to Cordyceps militaris and Cordyceps sinensis?-A review. Journal on Etnopharmacology. 2020 Apr 16:112879.

3. Healthline. 6 Benefits of Cordyceps all backed by Science. https://www.healthline.com/nutrition/cordyceps-benefits (Accessed on Oct 23, 2020).

4. WebMD. Cordyceps. https://www.webmd.com/vitamins/ai/ingredientmono-602/cordyceps (Accessed on Oct 23, 2020).

5. Pradhan BK. Caterpillar mushroom, Ophiocordyceps sinensis (Ascomycetes): a potential bioresource for commercialization in Sikkim Himalaya, India. International Journal of Medicinal Mushrooms. 2016;18(4).

6. Bao-qin Lin and Shao-ping Li. Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Since years ago, vitamin C has gained its popularity to be used for various functions from prevention of illnesses, alleviating symptoms for illnesses, and even in the cosmetics industry for skin care purposes. It has becoming popular after the Nobel prized scientist Linus Pauling started to consumed it (1). Following that there are many studies conducted on vitamin C and many people started to question its effectiveness and there are also many people who started to consume vitamin C for various purposes.

With regards to COVID-19 pandemic, many people started wanting to boost their immune system thus making the demand for vitamin C supplementation and food products containing vitamin C is even higher. However, is it true that vitamin C can boost immune system and prevent or treat COVID19?


What is vitamin C and how does it improve immune system?(2)
 

Vitamin C or also known as ascorbic acid, is a water-soluble vitamin. It can also act as antioxidant, which helps in protecting cells against free radicals thus helps with various kind of diseases. Vitamin C improves our white blood cells  (WBC) which function in fighting the viruses, bacteria, and generally foreign materials in the body. There are various studies with regards to this, one of it is the study that compare the administration of vitamin C and vitamin E as antioxidant, finding of the study noted that vitamin C give greater effect on body immunity as compared to vitamin E.

Vitamin C supplementation (4,5,6,7)

Vitamin C is found abundantly in fruits and vegetables especially citrus food. Also, if you look closely on the food labelled, there are food that is fortified with vitamin C such as breakfast cereal, milk etc. Local fruit that is high with vitamin C is guava, the amount of vitamin C in guava is even higher than in the orange.

As for cold, vitamin C has been a long popular remedy for common cold, which is why many people started to consume it when the pandemic strikes. Research shows that vitamin C does not reduce risk of getting common cold. Well, being sick once in a while, or get common cold once in a while is a good thing actually, it helps  antibodies to fight against pathogen (bad bacteria and viruses) and improve the immune system naturally. However, the consumption of vitamin C can lead to  a shorter period of common cold with milder symptoms. But the consumption of vitamin C after the symptoms of common cold is showing does not appear to be helpful.

With the COVID-19 pandemic, it’s especially important to understand that no supplement, diet, or other lifestyle modification other than physical distancing, also known as social distancing, and proper hygiene practices can protect you from COVID-19. However, since the symptoms is the same as common cold thus it is thought that it can be used to alleviate the same symptoms present. Currently researchers and physicians are studying the effect of vitamin C via (high dose intravenous) (IV) and also on the effect of supplementation taking on the new COVID19.

In conclusion, 

It is safe to say that, there is no harm in consuming vitamin C with the purpose to boost immune system in this pandemic situation, but also it has to be hand in hand with the other safety precautions such as only go out when it is necessary, must always adhere to the one meter social distance measure, must always wear mask when you are outside, must wash hands frequently using soap or hand sanitizer.

References

1. Oregon State University. Pauling Recommendation (2004). https://lpi.oregonstate.edu/mic/vitamins/vitamin-C/pauling-recommendation (Accessed on November, 16, 2020).
2. Healthline. 7 Impressive ways Vitamin C benefits your body. https://www.healthline.com/nutrition/vitamin-c-benefits ( Accessed on Nov 16, 2020)
3. 8 Nutrients that will optimize your eye health. https://www.healthline.com/nutrition/8-nutrients-for-eyes. (Accessed on Aug 26, 2020)
4. All About Vision. Lutein and Zeaxanthin. Eye and vision benefits. https://www.allaboutvision.com/nutrition/lutein.htm (Accessed on Aug, 26, 2020)
5. Simonson W. (2020). Vitamin C and coronavirus. Geriatric nursing (New York, N.Y.), 41(3), 331–332. https://doi.org/10.1016/j.gerinurse.2020.05.002
6. Medical News Today (MNT). Can Vitamin C Prevent or Treat COVID19.  https://www.medicalnewstoday.com/articles/can-vitamin-c-prevent-or-treat-covid-19 (Accessed on November 16, 2020).
7. Healthline. Can Vitamin C Protect you from Vitamin C. https://www.healthline.com/nutrition/vitamin-c-coronavirus (Accessed on November 16, 2020).

Pandemic COVID-19

The outbreak of Coronavirus disease began at Wuhan, China in December 2019, thus far it has infected more that 46 million of individual all around the world and has caused more than 1.2 million of deaths. The symptoms of COVID-19 include fever, cough, dyspnoea, and myalgia. Some proportion of confirmed cases also developed severe diseases which involves acute lung injury and acute respiratory distress syndrome (ARDS) which can precipitated into multiple organ failure and death. This is also one of the reasons why infection occur to the high-risk individuals are more likely be getting serious or lead to complications as compared to healthy individuals.

It has been reported that the condition is called ‘cytokine storm’, a condition where the host immune response becomes dysfunction due to the attack from the virus to body’s immune system. In the absence of approved vaccine to prevent this from happening, management of critically ill COVID19 patients include administration of azithromycin (antibiotic) and hydroxychloroquine (malaria medicine), this is due to that there is no specific medication yet for COVID-19.

However, growing study interest is seen on the administration of COVID-19 recently, where even in Malaysia, Ministry of Health has conducted few studies to see whether the usage of vitamin C among critically ill COVID-19 patients is beneficial. The first study was conducted among 17 patients, the critically ill patients were given 1g of vitamin C in every 8 hour for three days. Although the findings are promising, but according to Deputy Health Minister, Datuk Dr, Noor Azmi Ghazali, it cannot still be used as management of critically ill COVID-19 patients as the sample size of the studies is too small for the result to be used.

Another study involving critically ill COVID-19 patients, divide between two groups of critically ill patients, the one administered with Vitamin C and the one without administration of vitamin C. The result found out that group with vitamin C administration has 57% lower on mortality rate, 9 days shorter of hospital stay, 5.6 days faster in successful extubating, and 7.5 days faster in weaning off oxygen support.

There is another unpublished study that was conducted among critically ill COVID-19 patients in two different tertiary hospital in Malaysia comparing individual treated with vitamin C against those who are not treated with vitamin C. Both groups show similar clinical background, comorbidity, illness severity, and severity score on admission. The finding shows that the vitamin C group has lower mortality rate (14.3%) as compared to the group without vitamin C (71.4%). Duration of days on the ventilator were also shorter in vitamin C groups compared to non-vitamin C group (14 vs 19.6 days). Similarly, the duration to complete weaning of oxygen therapy was also shorter in vitamin C group (16 vs 23.5 days). Since the result is very promising currently, a multicenter randomized controlled trial is underway in evaluating the effectiveness of high dosage of intravenous vitamin C for the treatment for severe COVID-19 patients.

Usage of Vitamin C as prophylaxis to COVID-19 for general population

Apart from vitamin C is a water-soluble vitamin it is also a potent antioxidant. It acts as free radical scavenger and has its anti-inflammatory properties, which influence cellular immunity and vascular integrity. Which explain why it is being studied as one of the treatments for COVID-19. As for general population, National Health Service (NHS) U.K. treatment guideline stated that for non critically ill COVID-19 individuals and for non-COVID19 individuals there is insufficient data to recommend usage of high dosage of vitamin C in combating COVID-19. This being stated because, in critically ill COVID-19 individuals they experience high oxidative stress and severe inflammation, which may be helpful with the administration of vitamin C but unlike non COVID19 and non critical COVID19 individuals.

In general, sufficient consumption of vitamin C and healthy eating habit may helps with combating COVID-19 pandemic. A proper diet can help to ensure that the body is in the strongest possible state to battle the virus. Certain precaution with regards to food safety as well may helps in combating the virus although researchers have found that there is no source of virus contamination via food packaging or food. However, good food practices are always recommended to minimize the risk of contamination and to ensure that there is no window for the virus to weaken immune system.

• Eat plenty of fruits daily ( such as guava, apple, banana, strawberry, cantaloupe melon, grapefruit, pineapple, papaya, orange, Longman fruit, blackcurrant, pumelo) these are fruits have high vitamin C.
• Eat plenty of fresh vegetables daily (such as green bell peppers, garlic, ginger, kale, lime, coriander, broccoli, green chili pepper). Do not overcook vegetables as it leads to the loss of important nutrients such as vitamins and minerals.
• Eat whole grains and nuts, which have high amount of good fats! Limit intake of red meat, processed and fast foods.
• For snacks, choose fresh fruits and raw vegetables rather than foods that are high in sugar, salt or fat.
• Limit the salt intake to less than 6g/day.
• Drink 8–10 glasses of water every day. It helps to transport nutrients in the blood, gets rid of waste, and regulates the body temperature.
• Maintain a healthy lifestyle of exercise, meditation, and regular sleep. Adequate sleep will help to support immune function.
• Eat at home to avoid contact with other people and try to reduce the chance of being exposed to COVID-19.
• Wash vegetables and fruits before eating.
• Wash, rinse, and disinfect objects and surfaces every time before and after use.
• Keep cooked and raw foods separate, as it would prevent the harmful microbes from raw foods spreading to cooked foods. Use different chopping boards and utensils for cooked and raw foods to prevent cross-contamination.

References

1. Ministry of Health Malaysia (MOH). Kajian dan Penyelidikan MahTAS COVID-19 rapid evidence update. Intravenous Vitamin C for COVID-19. Based on the availa le evidence up to 16 November 2020. http://covid-19.moh.gov.my/kajian-dan-penyelidikan/mahtas-covid-19-rapid-evidence-updates/12_INTRAVENOUS_VITAMIN_C_FOR_COVID-19_editted.pdf (Access on Feb 2, 2021).
2. New Straits Times (NST). Vitamin C injections not used in COVID-19 treatment in Malaysia. https://www.nst.com.my/news/nation/2020/11/637714/vitamin-c-injection-not-used-covid-19-treatment-malaysia (Accessed on Feb 2, 2021).
3. National Institute of Health (NIH). Vitamin C usage and COVID-19. https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/vitamin-c/ (Accessed on Feb 2, 2021).
4. Feyaerts, A. F., & Luyten, W. (2020). Vitamin C as prophylaxis and adjunctive medical treatment for COVID-19? Nutrition (Burbank, Los Angeles County, Calif.), 79-80, 110948. https://doi.org/10.1016/j.nut.2020.110948
5. Aman, F., & Masood, S. (2020). How Nutrition can help to fight against COVID-19 Pandemic. Pakistan journal of medical sciences, 36(COVID19-S4), S121–S123. https://doi.org/10.12669/pjms.36.COVID19-S4.2776

Unsaturated fats can be classified into two main categories: Monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA). MUFA-rich foods include olive oil, canola oil, cashews, and groundnuts. On the other hand, PUFA can be further divided into Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), also known as omega-3 fatty acids. EPA and DHA are commonly found in fatty fish and algae.

Benefits of EPA and DHA

EPA and DHA offer a range of benefits, with one well-studied area being their connection to cardiovascular health. Multiple studies indicate that incorporating EPA and DHA-rich foods or supplements into the diet can lower triglyceride levels. Consequently, the American Heart Association (AHA) recommends a daily intake of about 1g of EPA plus DHA for individuals at high risk of heart disease. Joseph C. Maroon, MD, a professor in the Department of Neurological Surgery at the University of Pittsburgh School of Medicine and author of "Fish Oil: The Natural Anti-Inflammatory," emphasizes that sufficient omega-3 intake can reduce the inflammatory processes linked to various chronic conditions. This anti-inflammatory effect could potentially extend to diseases like arthritis, dry eyes, age-related macular degeneration (AMD), dementia, Alzheimer's, and cognitive issues. However, what about its relevance to COVID-19?

EPA & DHA in the Context of COVID-19

COVID-19 remains a novel disease, with many aspects still unknown to scientists. Among the potential management and treatment avenues being explored is the relationship between EPA and DHA and COVID-19. Numerous well-documented studies suggest that EPA and DHA's anti-inflammatory properties could have potential benefits for COVID-19 patients.

COVID-19 primarily targets the body's immune system, triggering an immune response to combat the disease. During this battle, the body releases cytokines, a phenomenon referred to as a "cytokine storm." Studies on sepsis patients have shown that administering EPA and DHA leads to the release of resolvins, which aid in restoring cellular function post-inflammation and tissue injury. This insight underlines why the administration and consumption of EPA and DHA-rich diets are being examined as potential mechanisms against COVID-19. Furthermore, a meta-analysis indicates that high EPA and DHA supplementation through parenteral and enteral nutrition can significantly reduce ventilator-free days, organ failures, ICU stays, and mortality rates among individuals with acute respiratory distress syndrome (ARDS). Given that ARDS is a common complication of critically ill COVID-19 patients, these findings suggest a potential positive impact.

Another critical parameter in assessing COVID-19 severity, particularly in critically ill patients, is coagulation ability. Non-survivors of COVID-19 are often those with heightened platelet aggregation and activation, resulting in a higher risk of life-threatening blood clotting. A study involving a moderate intake of three omega-3-rich fish species over 18 days showed improved bleeding time and reduced platelet aggregation, potentially decreasing thrombosis risk among COVID-19 patients. Similarly, a study supplementing healthy subjects with EPA for four weeks demonstrated decreased platelet activation, an early step in platelet aggregation.

In conclusion, the administration or consumption of EPA and DHA could potentially aid critically ill COVID-19 patients. However, using EPA and DHA as a prophylactic among healthy individuals requires further investigation due to the limited understanding of the virus's pathology and its interaction with patients' characteristics during recovery. Therefore, it's advisable to conduct randomized controlled trials that consider supplementation type, dosage, individual characteristics, adverse effects, and potential combinations with medication and antioxidants.

References

1. National Institute of Health (NIH). Office of Dietary Supplements. Fact sheet for consumer. Omega 3 Fatty Acids. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/ (Accessed on Feb 4, 2021).

2. National Institute of Health (NIH). Office of Dietary Supplements. Fact sheet for Health Professionals. Omega 3 Fatty Acids. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/ (Accessed on Feb 4, 2021).

3. Nourish by WebMD. What to know about Omega 3 and fish? Annie Stuart. https://www.webmd.com/diet/features/what-to-know-about-omega-3s-and-fish#1 (Accessed on Feb 4, 2021).

4. Rogero, M. M., Leão, M. D. C., Santana, T. M., de MB Pimentel, M. V., Carlini, G. C., da Silveira, T. F.& Castro, I. A. (2020). Potential benefits and risks of omega-3 fatty acids supplementation to patients with COVID-19. Free Radical Biology and Medicine.