Research Review: a look at the role of over- and under-nutrition and flu risk, fatalities over the last 100 years

{This article was summarized even more, and added to my overall research notes, which can be read at I update it regularly with new notes from published reviews}

Many Americans, while possibly consuming too many calories – are malnourished when it comes to actual nutrients and nourishment, therefore potentially increasing their risk of contracting a virus.

Notes from the article Back to the Future: Lessons Learned From the 1918 Influenza Pandemic

Ironically, a study was done in 2018 entitled “Back to the Future: Lessons Learned From the 1918 Influenza Pandemic” and made this observation: “Since 1918, the world has experienced three additional influenza pandemics: the 1957 “Asian” influenza pandemic, the 1968 “Hong Kong” influenza pandemic and the 2009 so-called “swine flu” pandemic. These pandemics, although mild in comparison to that of 1918, highlight the constant threat that influenza virus poses to human health. Given that almost 100 years have passed since 1918, it behooves us to ask: are we truly better prepared for the next influenza virus pandemic or are there still lessons to be learned?

In civil practice, we are following many of the same steps they did: try to clean up hospitals, use face masks, shut down maritime trade, ban mass gatherings, close schools and dance halls and churches. And like them, efforts were varied around the world, and had varying levels of efficacy.

But what did they find about nutrition and the pandemic, that could potentially apply today?

The 1918 Influenza virus was reconstructed and used in lab studies. Like I have talked about with SARS-CoV-2 or Covid-19, the 1918 virus “triggered a potent, dysregulated pro-inflammatory response, which likely contributed to the severe lung lesions” as observed in victims of the 1918 influenza pandemic. So again, dysregulated inflammation was an issue. Additionally, this over-reacting immune response has also been observed in natural and experimental infections with both the highly pathogenic avian H5N1 virus (“Bird Flu”) and the 2009 pandemic influenza virus (“Swine Flu”)

The 1918 influenza pandemic had a fatality rate of >2.5%, “certainly higher than other influenza virus pandemics” as of 2018. But now in 2020, while Covid-19 fatality rates range because of inconsistent testing, it is estimated at roughly the same rate, if not higher, than the 2.5% of the 1918 influenza pandemic.

But the death rate range was vast from country to country. Death rates ranged from 2.5 people per 1000 people in Argentina, to 445 per 1000 people in Camaroon. This is likely due to a large array of variables, which this article explores.

In addition to exploring genetics, single-nucleotide polymorphisms (SNPs, or genetic mutations), quarantines imposed, and prior exposure to flu strains as variables, this article also looked at the correlation of host factors and lifestyle – which is what I will cover below. Yes, there are many variables, so isolating any one is difficult; and correlation is not always causation. But the points found with lifestyle were interesting and still seem to hold true with what we see in more recent years.

Many variables can play in to the body’s ability to avoid or fight off infection


Host nutritional status has long been recognized as an important factor in the outcome of a variety of different infectious diseases. In India in 1918, the effects of malnutrition and famine on influenza severity were particularly pronounced.

[to note, per the USDA, 11.1 percent (14.3 million) of U.S. households were food insecure at some time during 2018. The majority of Americans are not consuming the recommended amounts of fruit, vegetables, whole grains, or calcium-rich foods. And the 2015-2020 Dietary guidelines for Americans highlighted that much of the US population is under-consuming calcium, potassium, fiber, iron, Vitamins A, C, D, and E, choline, and magnesium.  In short – many Americans, while possibly consuming too many calories – are malnourished when it comes to actual nutrients and nourishment, therefore potentially increasing their risk of contracting a virus.]

“in any future influenza virus pandemic, we will face a “double burden” of malnutrition whereby a proportion of the world’s population will experience severe disease because of undernutrition and a proportion of the world’s population will experience severe disease because of overnutrition. Specifically, it is now well accepted that obesity increases one’s risk of being hospitalized with, and dying from, an influenza virus infection (Morgan et al., 2010; Louie et al., 2011; Van Kerkhove et al., 2011). Perhaps of even greater concern is the fact that obesity inhibits both virus-specific CD8+ T cell responses and antibody responses to the seasonal influenza vaccine (Sheridan et al., 2012). The challenge for future influenza pandemics is therefore not only to protect those affected by undernutrition (in particularly in light of the growing problem of climate change), but also the growing number of people living with obesity.”

What that means: undernutrition weakens the immune system due to lack of nutrients but also, “overnutrition” and obesity was also inhibited the immune system response, inhibiting the types of cells (CD8+ T cells and antibodies) that fight off the virus. Antibodies are specific to a vaccine or strain of flu; CD8+ T cells offer a more blanket-protection against the general flu virus.

Undernutrition is still reported as a problem for influenza pandemics of the twenty-first century and beyond.

“Despite the advances that we have made in pandemic preparedness over the last 100 years, there are also several new challenges that we face in the context of twenty-first century (and later) influenza pandemics. Today’s population demographic is dramatically different to that of 1918. Today, a large percentage of the world’s population is either elderly and/or living with one or more chronic medical conditions [such as heart disease, obesity, asthma, chronic obstructive pulmonary disease (COPD), and/or diabetes mellitus]. The number of immunosuppressed individuals (due to untreated HIV infection, transplantation or/and chemotherapy) is also increasing. This changing population demographic is of significance as each one of these host factors is known to increase the severity of even mild influenza virus infections.”

Take Away

In all of this, the 1918 flu had two waves – one in spring, and a stronger one in fall. Could the Covid-19 surge be the same, as global lockdowns begin “the hammer and the dance” with letting up, see a slight rise, lock down… let up, see a rise, lock down.. that could usher in another round? Whether or not that is our future in 2020, consider making some lifestyle changes and bolstering your immune systems now for whatever may come in the next 2 weeks or next 2 seasons.

There may not be much we can do about some of the variables in the previous illustration, but there is are some areas we do have some power to affect. Take control of your health, and protect yourself and your loved ones.

Check out the Next Level Health page for various programs to help you reduce inflammation, boost immune strength, and reach your health goals.


Main Journal Article:

Short KR, Kedzierska K and van deSandt CE (2018) Back to the Future: Lessons Learned From the 1918 Influenza Pandemic. Front. Cell. Infect. Microbiol. 8:343

Supplemental Research Sources:

Research Review: COVID-19, enhancing prevention, protection through nutrition and lifestyle

Review of Webinar:

Current Controversies in Natural Therapeutics of Immune Support:
A roundtable discussion with three renowned clinicians

[Dr David Brady, Dr Todd Lepine, and Dr Peter D’Adamo)
Hosted by Designs for Health and Diagnostic Solutions, Jason Bosley Smith

The government, CDC, and Public Health leaders keep saying “it’s when, not if” you will get sick. So instead of just sitting back, hoping social distancing and hand washing keeps you out of the battle, start preparing your body now for the fire that is all but inevitable within the next few weeks, and take control. There are things you can do.

“We don’t necessarily die by having the virus in us, we die by our immune response’s over-reaction to the virus.”

–Dr Todd Lepine



The coronavirus produces a protein that kicks off this domino-chain reaction of inflammation in the lungs:

The virus triggers NLRP3 inflammasomes, which then triggers  IL-1β (Interleukin 1β, a pro-inflammatory cytokine), thus causing more inflammation. This cascade of inflammatory chemicals targets the thin membrane where your lungs and blood normally exchange oxygen and CO2, thickening the tissues and making the exchange difficult.  All of this uncontrolled progressive inflammation continues, and the diminished gaseous exchange leads to hypoxemia (below normal levels of oxygen in the body) and damages alveoli in the lungs. Patients often develop Acute Respiratory Distress Syndrome/Acute Lung Injury (ARDS/ALI). 

When you have the flu and feel “run over by a truck,” that is usually the result of excessive cytokines and inflammation. COVID-19 is similar, but those inflammatory agents more specifically attack the lungs.

What that means: the virus causes your body to release a host of chemicals that cause inflammation in the body. The inflammation seems to target the lungs in many patients, thickening up membranes there. This makes it harder to get oxygen from your lungs into your blood, and the CO2 back out – so breathing becomes more rapid and forced. This all results in shortness of breath and often an elevated heart rate.  [this is explained in a Facebook video here]. You need to reduce inflammation in your body now, and boost your immune system to prepare for anti-inflammatory protection later.


More recent research shows that the coronavirus is also very dominant in the GI (gastrointestinal) tract.

Digestive symptoms (such as nausea, vomiting, abdominal pain, or diarrhea) were tied to worse COVID-19 hospitalization outcomes: “Whereas 60% of patients without digestive symptoms recovered and were discharged, only 34.3% of the patients with digestive symptoms recovered.” The virus seems to be able to get into the GI tract; a strong and healthy gut may have a better likelihood of protecting your body from this invader.

What that means: in addition to inflammation in the lungs, many patients seem to have their gut lining attacked. The gut is one of the key aspects of health and immune protection. A damaged gut is often at the root of many other health problems. So if your gut is already weak, and gets attacked by the virus, it is a damaging circle that sets you up for more health problems later in life. Diabetes, autoimmune disorders, bone and joint problems, cardiovascular disease and more all have links to leaky gut and inflammation. You need to strengthen your gut health now to build better defenses and minimize your risks.


Various nutrients are essential for immunocompetence, particularly vitamins A, C, D, E, B2, B6, and B12, folic acid, iron, selenium, and zinc. Micronutrient deficiencies are a recognized global public health issue, and poor nutritional status predisposes to certain infections. These nutrient deficiencies are also seen as part of the aging process; but in a way, aging IS inflammation, possibly cyclically because of leaky gut and nutrient deficiencies. Diet alone may be insufficient, and tailored micronutrient supplementation based on specific age-related needs may be necessary, as well as person-specific needs (gender, exercise routine, stress level, genetics, diet, etc).

Vit D plays a huge role in preventing respiratory viral infections and decreases gene expression of various pro-inflammatory cytokines (such as TNF-α, IFN- β, ISG15, CXCL8, IL-6, and RANTES.)

Melatonin is a potent inhibitor of the NLRP3 inflammasomes; melatonin spikes in childhood and then tapers off as we age. This may be another reason children seem to have milder versions of this illness.

Nitric Oxide can inhibit NLRP3 inflammasomes. It also reduces oxidative stress (oxidation damages the body), regulates hypoxia signaling (helps get more oxygen to your body), supports the strength and integrity of your mitochondria (mitochondria are the “energy factories” in your cells, making energy for your body), and modulates the immune defenses to stem the progression of cytokine storms (boosts your immune system to help calm over-production of pro-inflammatory cytokines). Nitric Oxide is most commonly found in beets. 

Ascorbic acid (vitamin C) can inhibit NLRP3 inflammasomes in proper doses, which decreases the inflammatory IL-1b secretions, without inducing any cytotoxic effects or cell death. Best Vitamin C food is papaya, followed by bell peppers. [you can read more in my Facebook post about Vitamin C here.]

Elderberry should be safe if you’re not in respiratory distress. If you’re not symptomatic, Dr. Brady says he would keep taking it. “Cytokine Storms” usually mean the cytokines are boosted 6,000x normal; elderberry is meant to be a gentle therapy, and so typically only boosts cytokine levels 1.5-3x normal.

[Side Note: “Cytokine Storm” warnings have been flying around social media, telling people to avoid Advil and Elderberry and probably other “anti-inflammatory” or “immune boosting” items. Yes, Cytokine Storms are a real thing, where the boosting of pro-inflammatory cytokine triggers the boost of another, and in an inflamed body, this can become a dangerous downward spiral of health. But, there are many types of cytokines as you may have noticed in this reading, some pro-inflammatory, but others anti-inflammatory. And it takes a lot to trigger a “Storm.” Elderberry does boost a few pro-inflammatory cytokines that normally help gently kill off microbes, but in normal dosing is not likely to have a negative effect on a person because it is such a gentle therapy, especially if a person is asymptomatic.]

Stinging Nettle tea made from the leaves can help reduce the production of pro-inflammatory markers, such as TNF-α , IL-6, and CRP. Stinging Nettle root also has protective properties; it may have cytokines that kill off viruses and inhibit viral fusion. It has been shown to help protect against SARS. In mice, it also helped reduce fluid in the lungs, a common trait of pneumonia. 

Quercetin is being studied for its anti-inflammatory and immune boosting properties. It’s a pigment, found in many plants and foods: green tea, apples, berries, Brassica vegetables, capers, grapes, red wine, onions, shallots, tomatoes; many seeds, nuts, flowers, barks, and leaves; various kinds of honey. 

Resveratrol significantly inhibited MERS-CoV infection, and decreased its ability to replicate itself. So it is speculated that resveratrol may have similar effects on SARS-CoV-2. Found in red grapes

What that means: the foods you eat matter. Quality supplements matter. Find a clean eating diet, join my group for anti-inflammatory eating, or get personalized food help tailored to your specific inflammatory food sensitivities. 


When our immune system is balanced and working well, it can usually take care of things! 

“We don’t necessarily die by having the virus in us, we die by our immune response’s over-reaction to the virus.” A controlled inflammatory response towards infection is good. It is part of a healthy immune system. But an uncontrolled inflammatory response can cause complications, and COVID-19 poses a greater risk of triggering a systemic over-reaction. Complications include pulmonary edema (fluid, swelling), and the cytokine storm. It is these uncontrolled, over-reactions of the immune system and inflammatory response that have been associated with more severe disease states and higher mortality. Thus, lessening and suppressing the hyper-inflammatory response may be very beneficial in preventing immunopathology.

What that means: if you can build a strong immune system, and keep inflammation controlled, you may be able to help prevent getting sick, having such severe symptoms, and have a better chance for a longer, better quality life after all of this is over.

(or, at least, Fire-Resistant)

Think of the Coronavirus like an arsonist trying to set your home on fire. First, he has to make it to your home… then he has to get inside your home… then, he has to be able to ignite something. If you already have small fires in place, it is easier to fan those flames into something devastating. If you have flame-retardant materials everywhere, though, it will be more difficult. And, if he does happen to get something lit, it’s good to have a fire extinguisher available to try to squelch the little fire before it catches on to one thing then another, and quickly spreads through your house, destroying everything it can. How you protect your house, and have back-up plans, determines how great a chance you have at preserving your precious home.

Likewise, how you protect your body, and what healing systems you have in place, can reduce your risk of a devastating “fire” in your body, as the coronavirus sweeps through the country.

  1. So, keep your “home” (your body) away from the coronavirus exposure as much as you can! Stay home, avoid crowds, keep your physical distancing
  2. Keep the outside of your “home” strong and sanitized. Wash your hands; wipe grocery cart handles; clean after touching door knobs, car handles, delivery packages, etc; sanitize your countertops; wash work clothes immediately if your job keeps you in higher-risk areas; and practice other good general hygiene. 
  3. Put out current fires in your “home” as quickly as possible by reducing inflammatory foods and behaviors. 
    1. Cut way down on (or eliminate completely) processed foods, sugar, white flour/bread/pasta, high amounts of caffeine or alcohol, fried foods, margarine
    2. Remove common food sensitivities such as gluten, wheat, dairy, soy. Find out your specific food sensitivities
    3. Reduce exposure to toxic chemicals (cigarette smoke, pollutants, pesticides, sprays, fumes, etc)
    4. Reduce stress and cortisol
    5. Repay “sleep debt” from too many nights of too little sleep
  4. Make your “home” as fire-proof as possible.
    1. 70% of your immune system resides in your gut. So get it healed up.
    2. Get on high quality supplements (multivitamin, probiotic, omega-3s)
    3. Eat nutrient-rich foods with good antioxidants: dark, colorful vegetables; berries and other fruits; omega-3 fatty fish; whole grains or whole starches; nuts and seeds
    4. Get 7-8 hours of quality sleep every night
    5. Get sunshine daily
    6. Get your heart rate up at least 30 minutes a day
    7. Get off the couch, or out of the chair, and stretch every hour
    8. Drink more water
    9. Smile


over 30 research sources from this webinar and on this topic can be found here: