In a first, the Department of Home Science, Sri Padmavati Mahila Visvavidayalam (Women’s University) Tirupati, Andhra Pradesh, recently organized an international webinar on “Nutrition and Immune System Support during COVID-19 Pandemic”. Speakers included eminent national and international doctors, nutritionists, scientists and health experts.

Dr Raj Kumar Bhandari, member, National Technical Board Of Nutrition and Health, Mumbai, while speaking on the topic, “Importance of Nutrition in Supporting Immune System”, said that compared to our ancestors who were strong and sturdy and fought illnesses current generation is anemic. One in two children is anemic, one in three is stunted, one in four has low birth weight and one out of 5 children is undernourished which hugely impacts immunity.

Nutrition is the bedrock of immunity. Immunity could be innate or native, i.e., passed from our parents, and is the first line of defence of body. Immunity is also acquired or adaptive and got from B cells and T cells also called the fighter cells. In COVID-19 exaggerated response of cytokine storm and inflammatory substances (pathogens) jeopardize our health system and innate immunity is very important. When body is invaded by foreign pathogens native immunity the first line of defense through white blood cells called leukocytes.

Dr Bhandari explained that the immune system is complex and harmonized with cells, tissues and organs. It is interplay of cells and system that work together to overcome disease. By the age of 40, immunity starts declining. Under nutrition is the destroyer of immunity and it can be manifested with inter generational cycle from mother to child in the form of anemia, low birth weight, stunting and wasting. Deficiency of micro nutrients like type 1 (functional nutrients) which are required in small quantities leads to hidden hunger. These type 1 functional nutrients like iron, magnesium, calcium, copper, selenium, iodine, all fat soluble vitamins like A, D, C can be stored in the body. Type 2 are growth nutrients like nitrogen, phosphorous, potassium, amino acids, zinc, magnesium and  required on a daily basis for growth of body and immune system. He added that phytonutrients, omega 3 and protein are equally important for the immune system.

Obesity too destroys the immune system and gives rise to metabolic syndromes like Diabetes Type 2, Hyper cholestrolemia, hypertension and obesity itself. It disrupts our system and is an epidemic in waiting. Fatty lever could ultimately lead to cirrhosis, fibrosis and health disorder.
“By end-2020 we will have a large number of people suffering from these diseases including children as young as 15-20 years,” said Dr Bhandari as he cautioned that white poisons – refined salt, sugar and maida – are inflammatory in nature and reduce immunity. Pesticides-laden food, junk food, trans-fats, saturated fats and beverages deplete immunity and should be avoided.

“A large number of mental illnesses begin fromintestine. For example, in depression you would have a craving for sugar which is excellent food for fungi, cause leaky gut syndrome as nutrients will leak out of your gut,” he said.

Speaking about ways to boost immunity, Dr Bhandari said, “Balanced nutrition and good hydration which flushed out toxins are the key to immunity. Give up the idea of superfood. A diverse and balanced range of seasonal and regional food will fulfill nutrition needs of body. Let not your body not become a laboratory for experiments, and follow age-old wisdom of adhering to fresh, organic food. Certain yoga asanas also help our immune function.”

He said it is important to be active, however over-training can reduce immunity. On sleep he said lack of it disturbs rhythm and disturbs the immune system and it is important to get good sleep. Stress directly affects the immune system, so it is very important to de-stress and listen to your body. He advised referring to the Sanjeevani app of the Ayush ministry for boosting immunity against disease. He said in future more research will take place on spirulina and moringa supplements. 

“With the new normal we also have to look at old normal, i.e., our traditional food. The immune system is complex and it has to be in complete harmony with body.” Dr Bhandari also spoke on the health benefits of millets and said that the current crisis has taught us to include millets, which have been a staple food of our ancestors for more than 3,000 years, have immunogenic properties and therapeutic food. “The quality of diet is important. Demand must be created for sorghum which is excellent for diabetics and has low glycemic index. Millets combined with pulses give good amino acid profile,” he said.

Speaking on “Nutrition recommendations for Covid -19 patients and Nutrition advice for elderly during Covid-19”, Dr B Janaki, nutritionist, Diaita Eat Right Clinic, Hyderabad, said that we have two weapons against Covid-19 – immunity and social distance. The elderly are most vulnerable and need special care. It is very important to maintain normal or near normal values of sugar/blood lipids, body weight and hypertension. They must continue all medications, have well balanced diet and easily digestible foods, enough water and fluids, maintain proper sleep times to increase immunity, take regular exercise and physiotherapy, maintain bowels and must not go out.

She added that the factors influencing immunity are age, genetics, gender, nutritional status, neuro-endocrine immune regulation and physical status of the person. “Mucous membranes in nose and throat, tonsils, lymph nodes, thymus, spleen, bowel, mucous membranes in bladder and genitals, bone marrow and skin are the systems that must be intact for immunity and combat infection.” 

A well-balanced diet of  energy, protein, fat, Vitamins B, C and D, iron, calcium, zinc, fiber and phyto chemicals as per age, health status, morbidities if present, height and weight is very important for innate immunity and differs from person to person. For energy requirements during Covid, she says polymorbid patients more than 65 years of age require 27 klcal per body weight daily total energyexpenditure, severely underweight poly morbid patients require 30 klcal per body weight daily total energy expenditure, older persons depending on their health status require 30 klcal for per kg body weight. Less protein will give double burden on wasting. Older people require 1 gram protein per body weight. Fat plays major role in people in ICU for their energy requirements in the ratio of 30% fat and 70% carbohydrates. Fibre in fruits and vegetables give good bacteria and B12 lowers glucose and cholesterol levels.

During Covid-19 it is important to have a doctor’s prescription to take the amount of notional supplements and the period of dosage or it can cause nutrition injury. “When food you consume suits you it becomes super food for you! When a nutrient is not required you need not take it,” she says adding that with large population deficient in Vitamin D and B12 this will be an important nutrient status assessment in future.

Millets, a super food for Covid-19
Dr Benhur Dayakar Rao, principal scientist, IIMR, Hyderabad, spoke on “Developing and Branding of Millet Markets for Immunity Boosting during Covid -19 Pandemic” and said that millets offer food diversity and is a staple food of millions of people, is a dry land crop and grows in short duration of three months. Even with minimal purchase input yields are high and the crop is resilient to climate (C4 plant) and ideal contingent as a sustainable crop for food, fodder, nutritional health and fuel security.

Over the years, its production has drastically come down from 32 million hectares earlier to only 15.2 million hectares today, yet even today 60 million famers are involved in millets farming. Recent trends have shown that after value addition there is now a shift in demand from domestic oriented consumption to market oriented consumption.

With the government of India terming millets as nutria-cereals, ‘adbhut anaj’, and having  declared 2018 as ‘Year of Millets’ in line with the call of the union government, six states are on the millet mission at present. The Food and Agriculture Organization (FAO), United Nations, has declared 2023 as the ‘International year of Millets’. There is increasing focus on millets.  Technology has made millets available in ready to eat and consume form.

Millets lower bad cholesterol, prevent onset of breast cancer, help  prevent type2 diabetes, are effective in reducing blood pressure, protect against heart diseases  and respiratory conditions like asthma, help to optimize kidney, liver and immune system, and reduce risk of gastric ulcers. Being alkaline in nature they help in colon cancer, eliminate problems like constipation, excess gas, bloating and cramping. Millets perform different functions in our body to boost immune response towards pathogens, help in gut health maintenance due to soluble fibers and are rich in micronutrients. Phytonutrients in millets enhance both native and adaptive immune function and prevent infection among others, micro nutrients like zinc and selenium in millets helps in immunity boosting. Millets must be supplemented with existing diet to add nutrition.  

Millets are the last crops standing in times of drought, have lowest water and carbon footprints, resilient to thrive in harsh environment, highly efficient in absorbing and utilizing CO2 and amenable for intercropping systems. As compared to the sugar cane crop which requires 2,100 mm water and rice crop which requires 1,250 mm water, millets need only 350-400 mm water. “As water is going to be a scarce source in future, this will be an important factor and crops which can sustain and feed millions of people will be most dependable.”

Inconsistent availability and suitable variety of millet grains, lack of knowledge on processing interventions, lack of organized procurement systems, change in consumer taste and preferences and neglected policy front are major gaps in production, utilization and marketing. There is a major untapped market for millets which can be used for biofuel in starch industry, beer and brew industry and has low production cost as compared to other crops.

He also spoke on measures being taken by IIMR to promote millets. “We are developing value chain. Three thousand farmers were selected and along with our partners, ITC, we trained them for using these crops for profitability. As millets had become museum crops, the IIMR identified genotypes for specific end products. Without availability of data along with NIN (National Institute of Nutrition) nutritional evaluation and safety of selected millet foods was done. Clinical trials by NIN revealed a reduction in glycosylated hemoglobin levels among the diabetic patients from 7.9 to7.2 with the replacement of 50% food with sorghum millets.”

“As millets are too small, primary processing was a major challenge. The advantage here is it requires less labour and dehulling efficiency range is between 50-70%. The institute came out with recipes to promote millets, scaled up machinery with quality control lab and came out with cold extrusion with shelf life of up to six months to cater to consumer taste. For consumer awareness, the institute set up a ‘Jowar Rath’ a mobile exhibition van initially in Hyderabad and later across India. Six months ago, IIMR also came out with its own brand ‘eat rite’ Eat Jowar Stay Healthy. Now 400 millet brands are available in the market.”

The IIMR has been aggressively promoting millets through various platforms. The institute has now launched cooking with millets programmes. With the GoI establishing Centre of Excellence at IIMR, a national millet mission was launched in 2018 with IIMR as the nodal agency.

“Partnership with stakeholders and industries has led to more than Rs 100 crore business. The institute is now supporting and mentoring more than 400 start-ups. Total business is more than Rs 10,000 crore. More than 60 technologies have been readied for commercialization and processing of millets but Covid-19 has resulted in supply chain shocks by reducing inventory, resulting in rigid supply chains and affecting transparent supply chain,” said Dr Rao.

Going forward, he said the centre and the states need to come up with policies to mainstream millets into mass reach programmes like PDS, poshan abhiyan, mid-day meal scheme and others.  He recommended backward integration of millet based startups to bridge current, demand supply gap and developing data on immunity benefits of millets through clinical trials to establish evidence tests in addition to digitization of agriculture, shift towards variable cost models, diversification of risk of supply chain as markets open up and marketing that is inclined towards rural and localized models.   

“It is absolutely important to focus on all the millets rather than promoting only three millets,” he said, cautioning that “while there are studies on many of health benefits of millets, some of these things are yet to be proved. Unless clinical trials take place in a big way we cannot really substantiate.”