TY - JOUR
T1 - Cabbage and fermented vegetables: from death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID‐19
AU - ARIA Study Group
AU - Bousquet, Jean
AU - Anto, Josep
AU - Czarlewski, Wienczyslawa
AU - Haahtela, Tari
AU - Fonseca, Susana C
AU - Iaccarino, Guido
AU - Blain, Hubert
AU - Vidal, Alain
AU - Sheikh, Aziz
AU - Akdis, Cezmi A
AU - Zuberbier, Torsten
AU - Hamzah Abdul Latiff, Amir
AU - Abdullah, Baharudin
AU - Aberer, Werner
AU - Abusada, Nancy
AU - Adcock, Ian
AU - Afani, Alejandro
AU - Agache, Ioana
AU - Aggelidis, Xenofon
AU - Agustin, Jenifer
AU - Akdis, Cezmi A
AU - Akdis, Mübeccel
AU - Al‐ahmad, Mona
AU - Al‐zahab Bassam, Abou
AU - Alburdan, Hussam
AU - Aldrey‐palacios, Oscar
AU - Alvarez Cuesta, Emilio
AU - Alwan Salman, Hiba
AU - Alzaabi, Ashraf
AU - Amade, Salma
AU - Ambrocio, Gene
AU - Angles, Rosana
AU - Annesi‐maesano, Isabella
AU - Ansotegui, Ignacio J
AU - Anto, Josep
AU - Ara Bardajo, Paula
AU - Arasi, Stefania
AU - Arshad, Hasan
AU - Cristina Artesani, Maria
AU - Asayag, Estrella
AU - Avolio, Francesca
AU - Khuzamaazhari, null
AU - Bachert, Claus
AU - Bagnasco, Diego
AU - Baiardini, Ilaria
AU - Nisserabajrović, null
AU - Price, David
AU - Ryan, Dermot
AU - Sheikh, Aziz
AU - Walker, Samantha
PY - 2020/8/6
Y1 - 2020/8/6
N2 - Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage were associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin converting enzyme 2 (ACE2). As a result of SARS‐Cov‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT1R) axis associated with oxidative stress. This leads to insulin resistanceas well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block the AT1R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are given: Kimchi in Korea, westernized foods and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects helpful in mitigating COVID‐19 severity.
AB - Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage were associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin converting enzyme 2 (ACE2). As a result of SARS‐Cov‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT1R) axis associated with oxidative stress. This leads to insulin resistanceas well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block the AT1R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are given: Kimchi in Korea, westernized foods and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects helpful in mitigating COVID‐19 severity.
U2 - 10.1111/all.14549
DO - 10.1111/all.14549
M3 - Article
JO - Allergy
JF - Allergy
SN - 0105-4538
ER -