Pomegranate peel catechins – inhibition of NET formation

We could show that the flavonoids (−)-epicatechin, (+)-catechin hydrate, and rutin trihydrate as well as vitamin C and the pharmacological substances N-acetyl-L-cysteine and 5-aminosalicylic acid inhibited PMA induced ROS production and NET formation.” (1)

Why care about NET formation? because it may be associated with worse risk of coagulation and blood clots forming in severe COVID-19 illness. (3, 4) Interleuken-6 (IL-6) can increase NET formation by neutraphil white blood cells attempting to ensnare pathogens and IL-6 levels tend to be elevated in more severe COVID-19 illness.

NET-neutraphil extracellular traps: “Thrombosis [coagulation/blood clotting], sepsis, and thick mucous secretions share neutrophil extracellular traps as a common causal agent. In addition to phagocytosis and degranulation, neutrophils can kill pathogens by extruding neutrophil extracellular traps (NETs), a process termed NETosis.” (2)

Rutin is found in citrus peel and other plants. Epicatechin and catechin hydrate are in pomegranate peel or juice possibly (more in the peel). N-acetyl-L-cysteine is available as a supplement also known as NAC, and 5-aminosalicylic acid is a medication. Acetylsalicylic acid is aspirin and it also inhibits NET formation. (search results) Salicylic acid may be in some spices/plant foods. Many spices used in Indian cooking are good sources of salicylic acid. (post: Carrots, Spices, and baby aspirin help prevent cancer)

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Kirchner T, Hermann E, Möller S, et al. Flavonoids and 5-aminosalicylic acid inhibit the formation of neutrophil extracellular traps. Mediators Inflamm. 2013;2013:710239. doi:10.1155/2013/710239 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871909/
  2. Yanuck SF, Pizzorno J, Messier H, Fitzgerald KN, Evidence Supporting a Phased Immuno-physiological Approach to COVID-19 From Prevention Through Recovery. athmjournal.com/ https://athmjournal.com/covid19/research/evidence-supporting-a-phased-immuno-physiological-approach-to-covid-19-from-prevention-through-recovery/ *”interventions for one phase may not be appropriate for a different phase. The 4 phases addressed are: Prevention, Infection, Inflammation & Recovery.
  3. Thierry AR, Roch B. SARS-CoV2 may evade innate immune response, causing uncontrolled neutrophil extracellular traps formation and multi-organ failure. Clin Sci (Lond). 2020 Jun 26;134(12):1295-1300. doi: 10.1042/CS20200531. PMID: 32543703. https://pubmed.ncbi.nlm.nih.gov/32543703/
  4. Julie Kiefer, Clues to COVID-19 Complications Come from NET-Like Inflammatory Response. Jun 29, 2020, healthcare.utah.edu, https://healthcare.utah.edu/publicaffairs/news/2020/06/nets-covid.php

Citrus & Fig Marmalade Jam

Figs are also rich in quercetin (1) and pomegranate peel also contains significant amounts of the phytonutrient, (2). Quercetin can act as a zinc ionophore when zinc is present and carry the zinc into infected or cancerous cells where the zinc disrupts replication, see the last post, and Treatments vs ‘a cure’.

Orange Marmalade is a sweet jam made from citrus juice and peel. I made a modified low sugar version using the orange zest part of the orange peel that I had been removing when eating an orange with the white pith left on (see last post – it acts as a decongestant fairly quickly when eaten in that large of an amount (the whole orange with the white pith layer left on).

*This was an initial attempt and turned out too thick – just skip the jam part of the recipe if you want to simply make a fruit sauce preserve. Freeze the amount that you won’t be able to use fresh within a week or two as low sugar fruit sauces or jam are more likely to spoil – the large amount of sugar makes jams and jellies less likely to spoil. See: How does sugar act as a preservative? (sciencefocus.com) However if the goal is a way to preserve citrus peel for antiviral benefits than low sugar is going to be more supportive of immune function than a full sugar product.

— the point is not a recipe – the point is demonstrating a way to save time and preserve a large batch of outer citrus peel at once so small amounts can be used throughout the day and keep congestion cleared. Fruit preserves can be a mix as the jam package suggests and the basic ratios and which fruits might be more similar in acidity are grouped together on the instruction sheet pectin package.

*simpler way to get bioflavonoids in the diet of many people at once -add powdered citrus bioflavonoids citrus bioflavonoid powder to applesauce or yogurt or a smoothie type beverage or a breakfast porridge or soup. It is available in varied concentration. The preserved citrus jam could be used in a similar way but might be stronger in flavor than a concentrated powder.

I also had some fresh pomegranate peel on hand which I had peeled the outer more tannin rich layer from, (4), and an eight ounce package of dried figs and one pear for sweetness and to reduce the acidity somewhat.

Stevia is an herbal alternative sweetener which also has health benefits, including activation of the p53 protein, (3, also discussed in the last post), and I used a low sugar pectin mix that uses calcium to aid in gelling, Pomona’s Universal Pectin. It includes basic recipes that you can modify depending on your available fruit and sugar preferences. So without going into the specific jam details, here is a list of ingredients that I used, roughly estimating it as a double batch, however it thickened readily and I could have used pectin and calcium for one batch. (pomonapectin.com)

The cardamom powder and pomegranate peel cause the darker color, Citrus peel and fig would likely look more like a traditional orange marmalade.

Citrus Fig Savory Marmalade: Ingredient list (trial 1)

  • 2 1/2 cups minced orange peel
  • 1 1/2 cups minced inner pomegranate peel
  • 1 cup pear, peeled and minced
  • 1 1/2 cups figs, stem removed and minced, (8 ounce package dried)
  • 4 cups water
  • 1 tablespoon cardamom, powdered spice
  • 1 cup brown sugar – added to the stewing fruit, simmer gently to preserve phytonutrients, approximately 20 minutes to soften the citrus peel.
  • 6 tablespoons lime or lemon juice, bottled – for a double batch following the Pomona’s directions
  • 2 tablespoons of the calcium water solution – for a double batch
  • 1 cup Stevia sugar substitute with 1/2 cup = 1 cup sugar – measure into a separate bowl and mix in the pectin powder – to add to the fruit at the end, stir in thoroughly and let simmer for 1-2 additional minutes
  • 3 tablespoons of the Pomona’s pectin, (pomonapectin.com)

The jam cooled to a firm consistency, I could have used a single batch of lime juice, calcium water, and pectin. It made six cups which I froze most of and will keep the rest in the refrigerator as low sugar jams are more likely to mold/spoil than full sugar jam – the large amount of sugar acts as a preservative as it is too concentrated for bacteria to grow in, though mold may still occur. See: How does sugar act as a preservative? (sciencefocus.com)

The jam is mildly sweet and slightly spicy with the cardamom which also may have some antiviral and anticancer benefits by helping activate the p53 protein, which is involved in apoptosis – the killing and safe removal of infected or cancerous cells by our white blood cells. (6)

In addition to using a spoonful on toast, it is good added to a breakfast hot cereal or yogurt and would be easy to add to a cookie recipe if fresh orange peel isn’t available, see previous post: Dark Chocolate Orange Peel Cookies – Recipe.

Health can taste delicious. The taste buds will become more sensitive to the natural sweetness in foods after eating a lower sugar diet for a while.

The following is a series of jam/jelly recipes using citrus and pomegranate peel (fresh and/or dried/powdered). Both citrus and pomegranate peel have anti-inflammatory and other health benefits including antiviral properties.

The simplest way to prepare citrus peel for later use would be to mince the washed peel (collected over a few days in the refrigerator), and simmer it with water and a little brown sugar and possibly a spoonful of coconut oil or butter to help draw out fat soluble phytonutrients.

In a sauce pan bring the orange peel, 1 cup of water, 2 tablespoons of coconut oil & 1 tablespoon of stevia to a boil and remove from heat. (From Dark Chocolate Citrus peel Cookies recipe)

Citrus Plum: Ingredient list (trials 3 & 3.2)

  • 1 1/2-2 cups minced orange peel
  • 1 1/2 cups minced inner pomegranate peel and/or 6 tablespoons powdered dehydrated pomegranate, inner peel
  • 2 cups plums, minced
  • 1 cup prunes, minced,
  • 3 cups water – if more or less fresh fruit is available then adjust the water up/down to make up the difference, leaving a cup to simmer the citrus peel for a few minutes initially with the brown sugar, before adding the fresh plums and other ingredients.
  • 1-2 teaspoon cardamom, powdered spice
  • 1 cup brown sugar – added to the stewing fruit, simmer gently to preserve phytonutrients, approximately 20 minutes to soften the citrus peel.
  • 6 tablespoons lime/lemon juice, bottled, or 2 Tbs apple cider vinegar
  • 2 tablespoons of the calcium water solution – for a double batch
  • 1 cup Stevia sugar substitute with 1/2 cup = 1 cup sugar – measure into a separate bowl and mix in the pectin powder – to add to the fruit at the end, stir in thoroughly and let simmer for 1-2 additional minutes
  • 2 teaspoons of the Pomona’s pectin, (pomonapectin.com), if the 6 tablespoons of powdered dried pomegranate inner peel is used. The fresh pomegranate peel and citrus peel have pectin type fiber and less additional pectin may be needed to thicken the jam or jelly made with it, however the powdered dried peel is more thickening. Some additional pectin still seems to be needed for a full gel reaction

Additional trial, larger batch, notes – 2 cups citrus peel, 6 Tbs pomegranate peel powder, 2 cups brown sugar, 1 cup Stevia powder, 1-1 ratio equiv to sugar, 4 cups water, 4 cups fresh plums, 1 cup prunes, 1 Tbs cardamom, 1/2 cup lime or lemon juice, 2 Tbs calcium water, 2 teaspoon Pomono’s pectin (mixed with one of the cups of brown sugar).

The fruit jam can be made into a chocolate sauce or thicker ganache that can be used as a cookie or cake filling or frosting, or be made into chocolate truffle candies.

Citrus Chocolate Ganache/Fudge sauce

Simmer one-two cups of the citrus plum jam in a double boiler, – metal bowl that fits in a sauce pan that has a couple inches of simmering hot water – and add one teaspoon of vanilla, (optional), and one tablespoon coconut oil per cup of jam, stir until it is mixed in evenly, and then add 1/4 cup cocoa powder per cup of jam, stir until the powder is all incorporated into the chocolate fudge mixture. It will be lumpy because of the fruit pieces but the chocolate sauce should mix into a chocolate-y smoothness where there isn’t fruit pieces.

Whether the mixture will be a thin or thick sauce or a frosting like ganache texture depends on the ratio of cocoa powder to liquid that you use. Pomegranate juice could be used to thin the ganache if a sauce were needed. Thicker ganache can be rolled into truffle like dessert candies, coated with cocoa powder to prevent stickiness. Store and serve chilled from the refrigerator or freezer.

Chocolate citrus peel truffles (without a solid chocolate coating added).

Pomegranate Jelly, made with powdered pomegranate peel (and violets) – ingredient list

  • 6 tablespoons powdered dehydrated pomegranate, inner peel
  • 4 cups pomegranate juice
  • 1 cup violets, (optional) rinsed and drained gently
  • 1 cup brown sugar – added to the stewing fruit,
  • 2 Tbs apple cider vinegar or lime/lemon/juice (I was making a citrus free batch for people with allergy).
  • 2 tablespoons of the calcium water solution (if using Pomona’s Pectin)-
  • 1 cup Stevia sugar substitute with 1/2 cup = 1 cup sugar – measure into a separate bowl and mix in the pectin powder – to add to the fruit at the end, stir in thoroughly and let simmer for 1-2 additional minutes
  • 2 teaspoons of the Pomona’s pectin, (pomonapectin.com), if the 6 tablespoons of powdered dried pomegranate inner peel is used. The fresh pomegranate peel and citrus peel have pectin type fiber and less additional pectin may be needed to thicken the jam or jelly made with it, however the powdered dried peel is more thickening. Some additional pectin still seems to be needed for a full gel reaction
Pomegranate Jelly, made with powdered pomegranate inner peel, and violets (peppery). It was good served hot over a vegetable salad. Jam and jelly can be used as a tangy extra along with an entree (mint jelly and lamb, cranberry gelatin with turkey, chutney with Indian meals).
Purple violets and white with purple centers. If using edible flowers for cooking or fresh avoid chemically treated lawns or flowerbeds and private property or public lands.
More violets than lawn.

*Why violets? – they contain a fragrance phytonutrients that may help protect against retinal deterioration common with aging, and increase melanin production in the skin, helping protect against skin cancer potentially. How many violets is a serving? They are peppery, I enjoy eating a a few at a time.

Reference List

  1. Brian, 93 Quercetin Rich Foods, 2 October 2018, MyIntakePro.com https://myintakepro.com/blog/quercetin-rich-foods/ via @HiperacusiaCAT
  2. X. Zhao, Z. Yuan, Y. Fang, Y. Yin, and L. Feng, Flavonols and Flavones Changes in Pomegranate (Punica granatum L.) Fruit Peel during Fruit Development. J. Agr. Sci. Tech. (2014) Vol. 16: 1649-1659, http://citeseerx.ist.psu.edu/viewdoc/download?doi=
  3. Chen J, Xia Y, Sui X, et al. Steviol, a natural product inhibits proliferation of the gastrointestinal cancer cells intensively. Oncotarget. 2018;9(41):26299–26308. Published 2018 May 29. doi:10.18632/oncotarget.25233 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995179/
  4. J. Depew, G13. Pomegranate – Health Benefits and Preparation, effectivecare.info, https://effectivecare.info/g13-pomegranate
  5. Divya Sehgal, How does sugar act as a preservative?, sciencefocus.com, https://www.sciencefocus.com/science/how-does-sugar-act-as-a-preservative/
  6. Yu‐Jen Jou Chao‐Jung Chen Yu‐Ching Liu, et al., Quantitative phosphoproteomic analysis reveals γ‐bisabolene inducing p53‐mediated apoptosis of human oral squamous cell carcinoma via HDAC2 inhibition and ERK1/2 activation. Proteomics, 15;19, Oct 2015, pp 3296-3309, https://www.ncbi.nlm.nih.gov/pubmed/26194454

Eat Food – Antivirals are found in common foods.

Chloroquine medications are dangerous, many medications are dangerous especially if taken in too large a dose. Chloroquines are typically used to treat malaria, a condition caused by a parasite. The mechanism of action is that the chemical can hold onto the mineral zinc and carry it into an infected cell where the zinc disrupts the replication of proteins, causing less virus replication. (6) It has been mentioned as a medication that potentially may be helpful for treating patients with the novel coronavirus that is currently causing a pandemic.

The chloroquine medications are also used by autoimmune patients and supplies of the drug are limited. Increasing production is a goal but will likely take some time. (7) There are other safer alternatives available in foods or phytonutrient extracts (1, 8, 9) that have an immune modulating effect – promoting removal of infected or damaged cells while also inhibiting an overactive immune response.

People with a heart condition may also be at more risk of dangerous side effects if taking chloroquines. The medication also needs to be given with zinc to be as effective as possible. The food or phytonutrient alternatives would also need to be used with zinc in the diet or added as a supplement. (1, 8, 9)


***** ONLY EAT FOOD *****

Someone is dead because they consumed a household product containing chloroquine because they thought it might protect them from coronavirus infection, (10), – dead is not infectable by a virus, but dead is also dead.

Quercetin plus zinc is also an antiviral that works as a zinc ionophore, (1), however it is readily available in some common foods or as a supplement and is nontoxic to cells. (1, 2) The zinc is disrupting protein replication within the infected cell so the virus can not be replicated to spread to other cells, for more replication, more infecting other cells, more replication, etcetera.

Onions are the richest source of quercetin (4) and citrus peel is also a very rich source. (3) Pumpkin seeds are the richest source of zinc in a vegetarian diet and is commonly available in meats in a non-vegetarian diet.

Pomegranate peel extract or the inner white membrane of a pomegranate is also a source of quercetin and another phytonutrient that acts as a zinc ionophore (epigallichatechin-gallate). (1) It also would be nontoxic to healthy cells and low risk compared to the chloroquine medications. (2) However it can have some side effects, acting as a diuretic and has COX2 inhibition activity. (recent post, older post) A tablespoon or two of the liquid extract or inner white membrane can be enough to provide some health benefits for an adult. (G13: Preparation & Benefits of Pomegranate)

Onions, citrus peel, pomegranate peel – we have choices, safe choices, to help our body’s own defense system stop the coronavirus. Chloroquines do not kill coronavirus – it helps our own defense system do its job – but with more risk to healthy cells, and normal function than onions, citrus peel or pomegranate peel or quercetin supplements. Zinc is a trace mineral which we need in small amounts, a larger dose taken for a week or two would be unlikely to build up to toxic amounts but please be aware that in large doses a zinc supplement could become toxic.

Eat food – that is what our body is designed for. If the GI tract is inflamed and the idea of eating food is no longer appealing due to pain or constant diarrhea than please see the recent post: ACE2, Diarrhea, & COVID19 – it gets complicated. and try to eat small servings of something that might help heal and stop the inflammatory reaction in the intestinal tract.

If nausea and vomiting are also symptoms, hold off on the food and just sip water that has a dash of lemon or lime juice or apple cider vinegar. Those all have a type of acid that is similar to stomach acid. In cases of severe nausea even plain water can be unsettling and larger amounts of anything can be a problem. Start gradually with small sips of the lemon water, or a lime or lemon popsicle may be soothing and not cause more vomiting.

Once feeling better some of the mucilaginous or hydrolyzable tannin foods mentioned in the recent post (ACE2, Diarrhea…) can help replace the mucous lining that coats the intestinal tract during times of health. It also serves as a defense system, helping to prevent entry of virus or other pathogens into the body between intestinal cells. And white blood cells patrol the area and actively defend against pathogens.

Pomegranate peel also provides hydrolyzable tannins if the white membrane is used in prepared foods like a bean soup (G8: Cookies & Bean Soup/recipes) or sweet potato dish. Pomegranate peel and citrus peel and onions (less so) are also sources of vitamin C which also helps our body’s natural anti-viral defenses. (5)

Addition: Table of drugs and phytonutrients that are being investigated for use as a COVID19 treatment, (@rubbersoul23,Eric/table) based on A SARS-CoV-2-Human Protein-Protein Interaction Map Reveals Drug Targets and Potential Drug-Repurposing, March 23, 2020, (biorxiv.org)

Disclaimer: This information is provided for educational purposes within the guidelines of Fair Use. It is not intended to provide individual guidance. Please seek a health care provider for individualized health care guidance.

Reference List

  1. Husam Dabbagh-Bazarbachi , Gael Clergeaud, Isabel M Quesada, et al., Zinc Ionophore Activity of Quercetin and Epigallocatechin-Gallate: From Hepa 1-6 Cells to a Liposome Model. J Agric Food Chem, 62 (32), 8085-93 2014 Aug 13. https://pubmed.ncbi.nlm.nih.gov/25050823/
  2. Houston DMJ, Bugert JJ, Denyer SP, Heard CM. Potentiated virucidal activity of pomegranate rind extract (PRE) and punicalagin against Herpes simplex virus (HSV) when co-administered with zinc (II) ions, and antiviral activity of PRE against HSV and aciclovir-resistant HSV [published correction appears in PLoS One. 2017 Nov 20;12 (11):e0188609]. PLoS One. 2017;12(6):e0179291. Published 2017 Jun 30. doi:10.1371/journal.pone.0179291 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493292/
  3. Shafiya Rafiqa, Rajkumari Kaula, S.A. Sofia, et al., Citrus peel as a source of functional ingredient: A review. J of the Saudi Society of Ag Sci, 17;4, Oct. 2018, pp 351-358 https://www.sciencedirect.com/science/article/pii/S1658077X16300960
  4. Quercetin, Pharmacology, Toxicology and Pharmaceutical Science/Quercetin, ScienceDirect.com, https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/quercetin
  5. Kim Y, Kim H, Bae S, et al. Vitamin C Is an Essential Factor on the Anti-viral Immune Responses through the Production of Interferon-α/β at the Initial Stage of Influenza A Virus (H3N2) Infection. Immune Netw. 2013;13(2):70–74. doi:10.4110/in.2013.13.2.70 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659258/
  6. Xue J, Moyer A, Peng B, Wu J, Hannafon BN, Ding W-Q (2014) Chloroquine Is a Zinc Ionophore. PLoS ONE 9(10): e109180. https://doi.org/10.1371/journal.pone.0109180 https://journals.plos.org/plosone/articleid=10.1371/journal.pone.0109180
  7. Eva Schrezenmeier, Thomas Dörner, Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol 16, 155–166 (2020). https://doi.org/10.1038/s41584-020-0372-x https://www.nature.com/articles/s41584-020-0372-x
  8. Wang T1, Men R1, Hu M, et al., Protective effects of Punica granatum (pomegranate) peel extract on concanavalin A-induced autoimmune hepatitis in mice. Biomed Pharmacother. 2018 Apr;100:213-220. doi: 10.1016/j.biopha.2017.12.110. Epub 2018 Feb 9. https://www.ncbi.nlm.nih.gov/pubmed/29428670
  9. Hou L, Huang H. Immune suppressive properties of artemisinin family drugs. Pharmacol Ther. 2016;166:123–127. doi:10.1016/j.pharmthera.2016.07.002 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035609/
  10. Anne Flaherty, Sophie Tatum, Man dies after ingesting aquarium product containing chloroquine: Hospital network. March 23, 2020, abcnews.go.com, https://abcnews.go.com/Politics/man-dies-ingesting-chloroquine-prevent-coronavirus-banner-health/story?id=69759570

ACE2, Diarrhea, & COVID19 – it gets complicated.

The reason lung edema and diarrhea and other digestive symptoms (30) are potential symptoms of the novel coronavirus, (SARS-CoV2, also called COVID-19), and not infrequent as a way for the symptoms to start, (13); is because the virus is infecting cells by entering at ACE2 receptors. ACE2 receptors seem to have a role in cardiovascular health and they are more prevalent within the lungs and in the duodenum of the GI tract. ACE2 receptors also tend to be present in more quantity in men, in smokers, (people with excess weight will also have more, due to having more adipocyte/fat cells which also have ACE2 receptors, (32, 33)), and in people taking one of two different groups of medications.

It has also been confirmed…SARS-CoV-2 uses the same receptor, the angiotensin converting enzyme II (ACE2), as the SARS-CoV [11]”  “a 3D structural analysis indicated that the spike of SARS-CoV-2 has a higher binding affinity to ACE2 than SARS-CoV [23]

Xiaolu Tang, Changcheng Wu, Xiang Li, et al., On the origin and continuing evolution of SARS-CoV-2. 29-Feb-2020. (academic.oup.com/nsr/advance-article/doi/10.1093/nsr/nwaa036/5775463)

The ACE Inhibitors (list) block an enzyme involved in the chemical pathway and Angiotensin Receptor Blockers (ARBs, list) inhibit the ACE2 receptor in addition to inhibiting Angiotensin Receptors. Angiotensin is involved in the chemical pathway which gets complicated – watch the video: Coronavirus Pandemic Update 37: The ACE-2 Receptor – The Doorway to COVID-19 (ACE Inhibitors & ARBs). (1) (And for more information: an overview article on the ACE2/Angiotensin chemical pathway. (6))

Part of the complicated part is also the question of what to do about those medications while there is risk of infection – the consensus is, more information is needed. While having been on one of them may increase the risk of infection due to there being more ACE2 receptors than usual, stopping abruptly wouldn’t immediately get rid of the extra ACE2 receptors and the medications, particularly the ARBs which block the ACE2 receptors may have a protective effect once exposure to the virus occurs. (1)

As the viral infection advances in severity – more and more virus have been replicated and many cells are infected – the patient’s symptoms tend to become similar to genetic knockout mice bred to have zero ACE2 receptors. The mice don’t do well over time, developing cardiac problems and other symptoms similar to COVID19 patients with more severe cases. (1) If the viral load was very large than the patient’s ACE2 receptors might all have been filled with virus – making the patient phenotypically similar to a mouse with zero functional ACE2 receptors.

ACE2 enzyme is also present in the body in a free floating form, not just as a receptor embedded within cell membranes. A potential treatment possibility early in exposure would be to give the patient large amounts of the soluble ACE2, (7), – the free floating enzyme would attract virus to lodge into the enzyme but it would have no cell to enter and it is our cells, or another infected species cells in which virus are replicated. The viral design takes over our own gene replicating processes within the cell and set our own body to work making many many copies of the virus. When a cell is maxed out on replication of the virus the cell bursts and the many, many virus are free to circulate looking for more cells with ACE2 receptors to enter and set to more replication.

Symptoms include chest pain, difficulty breathing, a feeling that a breath isn’t really getting oxygen (because it isn’t, lung function is significantly reduced, requiring a ventilator or other breathing support). With more severe illness, all those infected cells that burst to release virus are dead and the area would have inflammatory damage from the cellular debris. Some patients who recover have been found to have continuing decreased lung function by ~ 20-30%, enough to leave them winded, short of breath, after minimal exercise such as walking. Reinfection also seems to be possible as the antibodies against the virus don’t seem to last very long. (4) Which suggests that pinning our hopes on a vaccine or herd immunity would be foolish.

Addition: As many of half of patients who tested positive for CoV-19, in nations that have been doing mass testing, have been found to have no symptoms or only very mild cough or fever, or even oddly, a loss of the sense of smell or taste – the virus may be affecting the olfactory bulb area of the nose and brain, which may be blocking nerve signals from the nose or mouth to the brain. (27) The brain has ACE2 receptors also, the significance of this symptom to long term health of the brain is unknown at this time. (29)

Of the patients testing positive two studies have shown an average of 17.9% had no symptoms and over half of people became infected in contact with some who had not developed symptoms yet. (28) This is why we need more testing to help stop spread of infection by people who don’t realize they are infected. In the meantime it would be cautious for everyone to practice Universal Precautions – avoid body fluids and respiratory droplets from everyone.

Diet tips that might help inflammatory GI symptoms.

Now, change of topic, what to do about diarrhea and other digestive symptoms? The digestive symptoms may include stomach pain/nausea, vomiting, and intestinal pain after eating, particularly after some types of foods. Inflammatory digestive conditions can be helped by eating foods that are similar to the layer of mucus that lines the intestines during normal health.

Foods that are mucilaginous – a little sticky and gooey – include:

  • the vegetable okra and the powdered sassafras leaves used in Creole gumbos known as Gumbo File.
  • Slippery Elm Powder is an ingredient in some herbal teas designed for use with a sore throat. Marshmallow Root Powder is very similar in healing benefits and a little less expensive than Slippery Elm Powder (and yes, marshmallows were originally made from Marshmallow Root Powder, now marshmallows are just another corn product).
  • Flax meal powder (21) when mixed with boiling water and stirred for two minutes will become mucilaginous and can be used as an egg replacer as it can act as an emulsifier. Gumbo File can also be mixed with boiling water and used in place of eggs as an emulsifier. It has a stronger flavor than flax meal powder but is a finer grind. Golden flax meal is slightly less gritty in texture than regular brown flax meal. Flax seeds are very tough and will not be digestible or chewable unless ground before use.
  • Egg replacer ratio that I use- 10 tablespoons water, bring to a boil and quickly remove before over-evaporating, stir into a bowl with pre-measured two tablespoons of Golden Flax Meal or Gumbo File. Stir for two minutes until thickened and the flax meal would turn the water from clear into an opaque creamy white color. Gumbo File is greenish and dark, and would be least noticeable in a chocolate brownie type of recipe.
  • Gelatin, bone broth, Jello (TM), are all mucilaginous from the collagen/gelatin from animal products. Agar is a vegetarian gelatin substitute made from seaweed and Irish Sea Moss can also be used to make gelatin like desserts. Tapioca starch can also be used to make a gelatin like dessert that is slightly more dense in texture than Jello (TM). The Gumbo File could be used to thicken fruit juice or fruit also for a gelatin dessert like effect but the flavor again might be more noticeable than if Agar, Tapioca Starch or traditional animal derived gelatin were used.
  • Psyllium Husk powder is a mucilaginous fiber sold as a fiber supplement and stool softener. (21) All of these mucilaginous foods could help with constipation by increasing moisture content of the bowel movement or help with diarrhea by helping absorb water content of the bowel movement as well as by reinforcing the mucus like lining of the intestinal tract.
  • chan (Hyptis suaveolens L.), chia (Salvia hispanica L.), or basil (Ocimum basilicum L.), all belonging to the Lamiaceae family, are applied to drinks or food with beneficial health effects. ” (21)
  • Aloe, cactus, Lotus Root, Chinese yams, See: Word of the Day: Mucilage.
  • Artichoke hearts/artichoke leaves are a better source of insoluble fiber (thedailymeal) which adds bulk to a bowel movement so it isn’t too watery and helps everything move along a little faster. A diet that has little fiber and more processed foods, refined grains, and meat and dairy products can take many days to pass through, increasing risk of cancer and constipation pain and hemorrhoids.
  • Jerusulem artichoke, carrot, turnip – (1850) These root vegetables would be a source of soluble fiber. Sweet potato and oat bran are also good sources of soluble fiber. (Mucilage/ScienceDirect) Black beans and other beans, nuts, seeds, broccoli, pears, nectarines, apricots, apples, guava, barley, figs, (Top 20 Foods Rich in Soluble Fiber)

Hydrolyzable tannins along with gelatin like foods can also be soothing during a diarrhea illness. (8) They help reduce inflammation by reducing the amount of the inflammatory chemical lipo-polysaccharides. (16) An excessive amount, an overly large serving of hydrolyzable tannins may increase irritation of mucus membranes so the rule holds: dose makes the poison, dose makes the cure. Hydrolyzable tannins are tannins that can bind with water and other molecules and form large complexes.

Condensed tannins don’t bind with water and are even more prevalent in leaves, making up as much as fifty percent of the tannin content within leaves of most plants. (12) Plants tend to make either condensed tannins or hydrolyzable tannins, but not both. The plant makes more in response to hotter sunny summer days, and in response to insect damage – the plant’s protection against cancerous effects of UV light, and a toxin if eaten in quantity by the insects. (17) See the Reference list for a longer list of plant sources of hydrolyzable tannins. (18)

Hydrolyzable tannins may help protect against cancer cells and other damaged or infected cells by promoting apoptosis (9) – the killing and engulfing of debris or a damaged cell by white blood cells. They have antiviral capability. (31) They also act as antioxidants and help reduce levels of oxidative chemicals. (19) Hydrolyzable tannins also act as COXII inhibitors (20) as do other antioxidants (last post).

Tannins are typically found in tea (tea leaves) and other tree leaves such as Sassafras leaves made into Gumbo File or Bay Leaves that are added to a soup broth at the beginning of cooking and removed before serving the food. Condensed tannins don’t bind with water and are even more prevalent in leaves, making up as much as fifty percent of the tannin content within leaves of most plants. (12)

Oak leaves are also a source of tannins, and are traditionally used to “tan” hides – with the tannin rich oak leaves. The initial soaking process with the tannin rich leaves prepares a deer skin so the hair can be scraped off the leather hide more easily – it still is a lot of work to tan a hide in the traditional way. Oak barrels are used in the aging of wine and liquors possibly because of the gradual addition of tannins to the aging alcohol product.

Walnuts also have hydrolyzable tannins and the binding of water and other nutrients is visibly noticeable when walnuts are cooked with sweet potatoes in a casserole – the dish can turn brown in color instead of the pretty orange color of sweet potatoes. It has not turned bad, it has hydrolyzed the tannins. The hydrolyzed tannins bind with other nutrients too and can slightly reduce nutrient availability for absorption out of the intestines , (15), – however if the goal is to heal inflamed and painful intestines than having more nutrients stay in the intestines may be part of the benefit – literally reforming the mucus lining of the GI tract that would be continually lost when severe watery diarrhea is an all day problem.

A larger quantity of tannins can also be obtained from pomegranate peel. The white inner part of the peel has slightly less than outer peel which makes it less bitter in flavor and less of a diuretic. Tannins have a diuretic effect and a larger serving of pomegranate peel products can have too much of a diuretic effect. I use a vegetable peeler to remove the outer reddish-purplish rind and then I separate the white membrane from the seeds and trim away any bad spots from the white membrane and remove any discolored or spoiled seeds.

The white membrane of the pomegranate peel can be minced and added raw to a salad or added to a soup. In foods that are acidic the color of the membrane and the dish you are preparing will become more reddish in color or might turn brownish if the tannins are hydrolyzing with other ingredients and the water content. In foods that are alkaline the color will turn brown. This is least noticeable in black bean soup, white beans will have a brown broth and greenish split pea soup looks odd (warning – foods are chemistry and this is kind of fun).

The red part of the peel can be used in tea or to make a liquid concentrate that is used in small amounts but it is too bitter to eat and the diuretic properties can be potent – have the extract or tea early in the day and drink plenty of water throughout the day to help it pass through before you hope to sleep through a night. Why would you bother then? Pomegranate peel has a long list of medicinal benefits potentially including cancer treatment or prevention. It is antimicrobial, anti-worm, etc, a long list, see this webpage for health benefits, preparation and menu ideas: G13: Pomegranate. A bean soup recipe using dry beans is the last recipe on page, G8: Cookies and Bean Soup.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Roger Seheult, MD, Coronavirus Pandemic Update 37: The ACE-2 Receptor – The Doorway to COVID-19 (ACE Inhibitors & ARBs). March 16, 2020, MedCram.com, https://youtu.be/1vZDVbqRhyM
  2. ACE Inhibitors Drug Class Side Effects, List of Names, Uses, and Dosage, MedicineNet.com, https://www.medicinenet.com/ace_inhibitors/article.htm
  3. List of Angiotensin Receptor Blockers, (ARBs), (Angiotensin II Inhibitors), drugs.com, https://www.drugs.com/drug-class/angiotensin-ii-inhibitors.html
  4. Menachery, V., Yount, B., Debbink, K. et al. A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence. Nat Med 21, 1508–1513 (2015). https://doi.org/10.1038/nm.3985 https://www.nature.com/articles/nm.3985
  5. The ASCO Post Staff, Pulmonary Pathology of Early COVID-19 Pneumonia Identified Retrospectively in Two Patients With Lung Cancer, ascopost.com, March 5, 2020 https://ascopost.com/news/march-2020/pulmonary-pathology-of-early-covid-19-pneumonia-identified-retrospectively-in-two-patients-with-lung-cancer/
  6. Carlos M. Ferrario, Jewell Jessup, Mark C. Chappell, et al., Effect of Angiotensin-Converting Enzyme Inhibition and Angiotensin II Receptor Blockers on Cardiac Angiotensin-Converting Enzyme 2. Circulation. 2005;111:2605–2610 https://doi.org/10.1161/CIRCULATIONAHA.104.510461 https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.104.510461
  7. COVID-19 Science Report: Therapeutics, NUS Saw Swee Hock School of Public Health, March 12, 2020, https://sph.nus.edu.sg/wp-content/uploads/2020/03/COVID-19-Science-Report-Therapeutics-13-Mar.pdf
  8. Frasca G, Cardile V, Puglia C, Bonina C, Bonina F. Gelatin tannate reduces the proinflammatory effects of lipopolysaccharide in human intestinal epithelial cells. Clinical and Experimental Gastroenterology. 2012 ;5:61-67. DOI: 10.2147/CEG.S28792. http://europepmc.org/article/PMC/3358810
  9. Hydrolysable tannins had cytotoxic effec on leukemia cells, caused apoptosis https://books.google.com/books?id=uRHwlkQVS2QC&pg=PA764&lpg=PA764&dq=Blastocystis+hominis+hydrolysable+tannins&source=bl&ots=CKm1JLwdhj&sig=ACfU3U11YQo6Plk3wjd-KsihXREUtNwjIg&hl=en&sa=X&ved=2ahUKEwjNiaKL7PHnAhUDP6wKHcsBByIQ6AEwGHoECAsQAQ#v=onepage&q=Blastocystis%20hominis%20hydrolysable%20tannins&f=false
  10. Punicalagin – an overview, ScienceDirect.com Punicalagin – ScienceDirect.com
  11. Neuroscience/Punicalagin, ScienceDirect.com www.sciencedirect.com › topics › neuroscience › punicalagin
  12. Tannin, Wikipedia.com, https://en.wikipedia.org/wiki/Tannin
  13. Study Suggests Digestive Symptoms May Be Associated with COVID-19. drugtopics.com, March 18, 2020, https://www.drugtopics.com/latest/study-suggests-digestive-symptoms-may-be-associated-covid-19
  14. Word of the Day: Mucilage, Nov. 2, 2011, FoodRepublic.com, https://www.foodrepublic.com/2011/11/02/word-of-the-day-mucilage/
  15. Anti-nutritional Effects of Condensed and Hydrolyzable Tannins, 1992, https://link.springer.com/chapter/10.1007%2F978-1-4615-3476-1_40 
  16. Frasca G, Cardile V, Puglia C, Bonina C, Bonina F. Gelatin tannate reduces the proinflammatory effects of lipopolysaccharide in human intestinal epithelial cells. Clinical and Experimental Gastroenterology. 2012 ;5:61-67. DOI: 10.2147/CEG.S28792.  http://europepmc.org/article/PMC/3358810
  17. Erick Paul Gutiérrez-Grijalva, Dulce Libna Ambriz-Pére, Nayely Leyva-López, Ramón Ignacio Castillo-López, José Basilio Heredia Review: dietary phenolic compounds, health benefits, and bioaccessibility. ALAN 66:2 2016 https://www.alanrevista.org/ediciones/2016/2/art-1/ *Hydrolyzable tannins “In the case of tannins, hydrolysable tannins are characterized by a restricted taxonomic distribution and are mainly associated with dicotyledonous plants; it has also been observed that most of the plants that can synthesize hydrolysable tannins are unable to synthesize condensed and vice versa (100).” Tannin production is increased with more UV radiation to the plant and in response to some insect damage. (Note to self, 5, in this doc)
  18. Susan G. Wynn, DVM, Barbara Fougere, Veterinary Herbal Medicine, Elsevier Health Sciences, Nov 29, 2006 https://books.google.com/books?id=iLbZDzumqt0C&pg=PA327&lpg=PA327&dq=sassafras+leaves+hydrolyzable+tannins&source=bl&ots=qSTuWQ1XbN&sig=ACfU3U0cgrerOFCe7IFXq2xp49NPrgXKuQ&hl=en&sa=X&ved=2ahUKEwjC5u73rZ_nAhXBB80KHQEXAXUQ6AEwDXoECA4QAQ#v=onepage&q=sassafras%20leaves%20hydrolyzable%20tannins&f=false Sassafras leaves book page – Agrimony (Agrimonia eupatoria), Tormentil, (Potentilla tormentilla) , Blackberry, (Rubus fructosis), Cranesbill, (Geranium maculatum), Artichoke, Bayberry, Bilberry, Black cohosh, Blue Flag, Borage, Cascara, Cassia, Chamomile (German), Cinnamon, Clivers, Comfrey, Cornsilk, Elder, Ephedra, Eucalyptus, Eyebright, Feverfew, Gentian, Hawthorn, Hops, Horse chestnut, Juniper, Marshmallow, Meadowsweet, Nettle, Pilewort, Plantain, Poplar, Prickly Ash, Raspberry, Rhubarb, Sage, Sassafras, Saw palmetto, Skullcap, Slippery elm, St. John’s Wort, Tansy, Thyme, Uva ursi, Valerian, Vervain, Willow, Witch Hazel, Yarrow, Yellow Dock. book page
  19. Proanthocyanidins and hydrolysable tannins: occurrence, dietary intake and pharmacological effects. https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/bph.13630Tannins exert several pharmacological effects, including antioxidant and free radical scavenging activity as well as antimicrobial, anti-cancer, anti-nutritional and cardio-protective properties. They also seem to exert beneficial effects on metabolic disorders and prevent the onset of several oxidative stress-related diseases.” “
  20. Hydrolyzable tannins as COX2 inhibitor, dif book page 
  21. José Manuel Cruz-Rubio, Renate Loeppert, Helmut Viernstein and Werner Praznik, Trends in the Use of Plant Non-Starch Polysaccharides within Food, Dietary Supplements, and Pharmaceuticals: Beneficial Effects on Regulation and Wellbeing of the Intestinal Tract. Sci. Pharm. 2018, 86(4), 49; https://doi.org/10.3390/scipharm86040049 https://www.mdpi.com/2218-0532/86/4/49/htm
  22. H. Panda, Handbook on Drugs from Natural Sources, Asia Pacific Business Press Inc., Oct 1, 2010, https://books.google.com/books?id=2qRaAgAAQBAJ&pg=PT115&lpg=PT115&dq=sassafras+leaves+hydrolysable+tannins&source=bl&ots=uX153bFwL_&sig=ACfU3U3ZFst6bHi2I7YIePs1AUF8kA0Cag&hl=en&sa=X&ved=2ahUKEwiZi9TgxJ_nAhUUG80KHepcAXYQ6AEwF3oECAsQAQ#v=onepage&q=sassafras%20leaves%20hydrolysable%20tannins&f=false
  23. Christian Kogler, Why You Should Be Eating Artichoke Hearts and 9 Ways to Cook With Them. Feb 18, 2016, thedailymeal.com, https://www.thedailymeal.com/healthy-eating/why-you-should-be-eating-artichoke-hearts-and-9-ways-cook-them
  24. Mucilage, ScienceDirect.com, https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/mucilage
  25. Keith Imray, A Popular Cyclopedia of Modern Domestic Medicine: Comprising Every Recent Improvement in Medical Knowledge, with a Plain Account of the Medicines in Common Use, Gates, Stedman, 1850 https://books.google.com/books?id=8-QrAQAAMAAJ&pg=PA122&lpg=PA122&dq=artichoke+mucilaginous+food&source=bl&ots=F88wll8DOg&sig=ACfU3U31lUeCt3WobMiO6M8TmMULu-iyMQ&hl=en&sa=X&ved=2ahUKEwjvwZCgzKnoAhVSS6wKHa5vBBAQ6AEwCnoECAwQAQ#v=onepage&q=artichoke%20mucilaginous%20food&f=false
  26. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol. 2015;1282:1–23. doi:10.1007/978-1-4939-2438-7_1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369385/
  27. Ryan W Miller, There’s a new symptom of coronavirus, doctors say: Sudden loss of smell or taste. March 24, 2020, usatoday.com https://www.usatoday.com/story/news/health/2020/03/24/coronavirus-symptoms-loss-smell-taste/2897385001/
  28. Bruce Y Lee, Study: 17.9% Of People With COVID-19 Coronavirus Had No Symptoms. March 18, 2020, Forbes.com https://www.forbes.com/sites/brucelee/2020/03/18/what-percentage-have-covid-19-coronavirus-but-do-not-know-it/#10bd1c187e90
  29. Abdul Mannan Baig, Areeba Khaleeq, Usman Ali, and Hira Syeda, Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host−Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem. Neurosci. https://dx.doi.org/10.1021/acschemneuro.0c00122 https://pubs.acs.org/doi/pdf/10.1021/acschemneuro.0c00122?ref=vi-chemistry_coronavirus_research
  30. Lei Pan, Mi Mu, Pengcheng Yang, et al., Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Preprint. https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf?utm_source=yahoo&utm_medium=referral&utm_campaign=in-text-link
  31. Pietro Buzzini, Panagiotis Arapitsas, Marta Goretti, et al., Antimicrobial and Antiviral Activity of Hydrolysable Tannins. Mini Reviews in Medicinal Chemistry 8(12):1179-87 · December 2008 https://www.researchgate.net/publication/23319589_Antimicrobial_and_Antiviral_Activity_of_Hydrolysable_Tannins
  32. Jia, X.; Yin, C.; Lu, S.; Chen, Y.; Liu, Q.; Bai, J.; Lu, Y. Two Things about COVID-19 Might Need Attention. Preprints 2020, 2020020315 (doi: 10.20944/preprints202002.0315.v1). https://www.preprints.org/manuscript/202002.0315/v1
  33. Sanjum S. Sethi MD, MPH@sanjum· Thread with observations about obesity and renal deaths due to COVID19, https://twitter.com/sanjum/status/1249374582110408712?s=20