Covid-19 has resulted in a global pandemic which has to date infected more than 3.56 million and nearing 250,000 deaths reported globally. With much of the world practicing social distancing via some form of stay-at-home orders, many countries may be facing health crises and the global economy has been impacted to the tune of several trillion dollars. With no effective cure until a suitable vaccine is developed, the outlook in the near term remains uncertain.
Recently the WHO produced a series of flyers and social cards for the Eastern Mediterranean Region on “Nutrition advice for adults during the Covid-19 outbreak” to assist populations towards a healthier lifestyle. Unfortunately, WHO seems to have dropped the ball…again!
Instead of producing advice appropriate for a fast spreading pandemic, they appear to have regurgitated standard talking points (eat low fat diets, avoid salt, sugar, processed and red meats, avoid full-fat dairy etc.). It is clear that very little thought has been given to the issues that are prevalent currently and directly related to the pandemic.
As national lock-downs are in place, supply-chains are impacted, household incomes have dropped, markets and stores may not be receiving supplies in a timely manner, farming has been stalled in many regions, and access to food is becoming trickier.
The pandemic actually necessitates radically different health management ideas, but instead WHO seems to have fallen back on antiquated messages that are meaningless for many individuals especially in countries experiencing rigorous Covid-19 induced restrictions to daily life. As data accumulates on the impact of Covid-19, it is already apparent that mortality has been higher in elderly individuals (>60 years of age), men have been impacted more than women, as have individuals with pre-existing conditions (e.g. hypertension, cardiovascular disease and diabetes).
A debate has already started on the role nutrition played in exacerbating pre-existing conditions in certain individuals, and this will lead to new paradigms which may be counter to the ideas that WHO promoted for the Eastern Mediterranean region, especially its stated advisory on the role of fat/saturated fat and dietary carbohydrates.
Overall nutritional well-being requires optimal intake of macronutrients (fat, protein and carbohydrates) along with numerous micronutrients (vitamins and minerals). For Covid-19, individuals with pre-existing conditions (cardiovascular disease, diabetes, hypertension, HIV/AIDS) and/or a compromised immune system, appear more susceptible to infection.
A poor immune system is also prevalent in undernourished individuals. Hence there is an increased challenge during Covid-19 of ‘boosting’ the immune system, with ‘immune-boosting’ foods and/or supplements. However, caution must be exercised when evaluating claims lacking scientific credibility as there is no solid data for “magic foods”.
The hallmark of a balanced nutritious diet (based on e.g. whole grains, vegetables and legumes, fish and minimally processed foods) which meets vitamin and mineral needs and provides adequate calories is well established. The use of natural antioxidants (vitamins A, C, E, various carotenoids) which can be obtained from fruits and vegetables can also help to mitigate inflammatory responses.
Some studies with Vitamin D supplements have shown potential benefits; however, in most cases being in the sun for 20-60 minutes will suffice (based on skin pigmentation) to boost vitamin D reserves. Similarly supplements of Zinc, Selenium and the likes may promise quick fixes, but the underlying evidence against Covid-19, is far from certain.
Also, as is the case in ‘normal’ times, under and over nutrition in specific countries, are driven by local health policies. With regards to dietary fats a major source of calories, WHO through its most recent advisory has again fallen into the same previous well of promoting certain commodity oils while brushing aside palm oil - the world’s leading edible oil in terms of production, exports and indeed consumption trends. On previous occasion WHO’s indulgence in the matter of palm oil, attracted severe criticism for its insufficient and inconclusive claims that bedeviled palm oil.
In this regard, the Asian region is especially important as it is home to both the largest producers (Indonesia and Malaysia) and the largest consumers (Indian Sub-Continent, China, ASEAN and Africa) of palm oil. While the impacts of Covid-19 to local production, subsequent distribution and export is currently in a state of flux, if the fallout from the current pandemic continues into the foreseeable future, the nutritional role of palm oil is anticipated to take on even greater significance given its functionality and affordability. As such having a viable palm-oil sector will be even more important to meet global nutritional demands post the current pandemic.
In developed countries, particularly those where caloric consumption is generally above body requirements and chronic disease is the major health issue, the focus of public health agencies, prior to Covid-19, has been on the consumption of total, saturated and trans fat. The negative role of the latter (trans fats) in increasing risk for cardiovascular disease has now been firmly established and health authorities have put restrictions on their use.
The major source of trans fats are the partially hydrogenated vegetable oils produced industrially. These were required to provide a source of ‘solid’ fats to allow for the formulation of various baked goods. Currently, nutrition food labels need to list content of trans fats and/or partially hydrogenated vegetable oil content, allowing the consumer to minimize their usage.
Over the last decade, numerous studies have re-evaluated saturated fat effects on CVD with growing evidence that its role may have been over played and that attention needs to focus on dietary carbohydrate type instead. Recently a nutrition coalition “petitioned’ US Dietary Guidelines Committee to remove restrictions on saturated fat intake. In support of this, ongoing studies evaluating dietary intake across several countries have found that the prominent dietary determinant of CVD risk is trans-fat and refined carbohydrates.
While there is evidence for health benefits of omega-3 rich fats, there is growing discussion about the health effects of omega-6 rich fats, especially if they are used for deep frying. These include corn, soya, sunflower, canola and rapeseed oils. In such instances, adverse effects on heart health may result despite apparent beneficial changes in blood cholesterol levels.
As there is no single fat source which is uniquely saturated, mono or polyunsaturated – a simple concept of having a balance between these types of fats is inherent in most dietary guidelines. This can be obtained by not focusing on the use of a single type of fat but rather using different sources to ensure appropriate intakes of the various types of fats.
In countries where fat consumption is below recommendations of the WHO, as is the case in large parts of Asia and Africa, health focus is different. The need to provide a reliable, sustainable and affordable source of calories to ward of undernutrition (and increased susceptibility of infection) is paramount.
Additionally, having adequate fat to ensure absorption of various dietary micronutrients (e.g. fatsoluble vitamins) is of primary importance. In this regard palm oil offers several advantages which include the fact that it has a natural balance of saturated and unsaturated fats, it does not require hydrogenation and is available in large quantities.
While the immediate need in controlling Covid-19 are the measures in place (social distancing, frequent hand washing), as different regions aim to ‘flatten’ the curve, various sectors of the economy will come back online. Focus will then shift to long term health of the global population.
Palm oil’s role in meeting nutritional needs will again move to center-stage and a collective effort will be needed to coordinate production, distribution and delivery. Malaysian palm oil is set and ready for these challenges!
Datuk Dr. Kalyana Sundram, is CEO Malaysian Palm Oil Council (MPOC) and is an established researcher specializing in oils and fats health, nutrition and technology.
Dr. Pramod Khosla, is Associate Professor, Food Science and Nutrition Department at Wayne State University, Detroit, MI, USA and researches on nutrition in cardiorenal health.
The views expressed herein are solely the responsibility of the authors.