The dreaded ‘winter vomiting bug’ threatens to wreak havoc on the start of our festivities. There is currently no conventional treatment, [i] so read on to learn how nutrition and lifestyle may help you avoid infection, and support you during and after infection if it comes to that.
What is Norovirus and who's at risk?
Norovirus is the infamous microbe responsible. The symptoms of winter vomiting bug include severe diarrhea and vomiting, and often fever, muscle aches, and weight loss too. Anyone can pick up this pesky bug, however young children, the elderly, and immunocompromised individuals are most vulnerable. [ii]
Symptoms usually only last 2-3 days, but norovirus can disrupt our health for several months, if not years, after the infection has cleared. It can trigger post-infectious irritable bowel syndrome (PI-IBS)[iii],[iv] and this is certainly what we observe in clinical practice.
We are unavoidably exposed to norovirus, from workplaces and eateries[v] to the food[vi],[vii] and water[viii] that we consume, particularly during winter.[ix] So how can we protect ourselves?
Self-care action plan
Keep your immune system nourishedwith the nutrients it requires to function properly, chiefly those with anti-viral properties such as beta-glucans,[x]zinc,[xi]lysine,[xii] and vitamin A,[xiii]C[xiv]and D.[xv] Vitamin A has specifically been shown to reduce the prevalence of norovirus and associated diarrhea, [xvi] likely by improving gut barrier function,[xvii] boosting innate and adaptive immunity,[xviii] and according to preliminary research, supporting the ability of the gut microbiome to inhibit norovirus replication.[xix],[xx]Consider supplementing them on a daily basis from a therapeutic multinutrient to work on prevention, and at a higher dose from a targeted immune complex during and after norovirus infection to aid recovery.
Optimise yourvitamin Dstatus guided by avitamin D test. We are all prone to sub-optimal vitamin D levels during winter and the last thing we need is something as basic as this increasing our infection risk.[xxi] Increase your intake of vitamin D rich foods and contact a Registered Nutritional Therapist for tailored advice. Adults and children can start by taking a conservative daily dose of 1000 IU and 400 IU vitamin D3 respectively.
Support the resilience of the gut to infection by increasing your intake ofprebiotics(the fibre)[xxii]andprobiotics(the good bacteria),[xxiii],[xxiv] alongside supportive micronutrients, notably vitamin A and vitamin D.[xxv],[xxvi]Enjoy foods such as onions, garlic, leeks, Jerusalem artichoke, raw sauerkraut, and kefir on a daily basis. To help you reach a therapeutic dosage, consider supplementing with prebiotics and well-researched human strains of beneficial bacteria, such as Lactobacillus acidophilus, Bifidobacterium lactis, and Bifidobacterium bifidum. The LAB4 combination can stave off intestinal pathogenic overgrowth[xxvii] and support the barrier function of the gut wall.[xxviii] Certain Lactobacilli strains, including Lactobacillus rhamnosus GG, may directly inhibit norovirus[xxix] and improve gut function following viral gastroenteritis.[xxx]
Support your gut wall during and after infection with prebiotics and probiotics alongside targeted nutrients such as vitamin A, zinc,[xxxi] and L-glutamine, to improve the rate of recovery and minimise the risk of lingering symptoms. For instance, L-glutamine supplementation by those with diarrhea predominant PI-IBS can improve intestinal permeability and gut symptoms.[xxxii] During infection and at least the month after, minimise those dietary factors which can irritate the gut wall, principally dairy[xxxiii] and gluten,[xxxiv] and focus on soft foods (e.g. smoothies, soups, stews) and hydration.
Prioritise sleep.Sleep is the opportunity for our body to ‘rest and repair’ and is just as important as nutrition when looking to strengthen our immune system. Aim for 7-8 hours uninterrupted sleep per night with the help of an eye mask, ear plugs, increased intake of calming nutrients such as magnesium,[xxxv] and meditation before bed.
Watch your sugar and alcohol intake. Try to choose healthier alternatives, such as dark chocolate, nuts, and non-alcoholic drinks (e.g. kombucha), and encourage your colleagues and family to do the same.
If you would like personalised advice, please contact our Clinical Nutrition team or seek the advice of a private Registered Nutritional Therapist.
[ii] Schwartz S et al. Norovirus gastroenteritis causes severe and lethal complications after chemotherapy and hematopoietic stem cell transplantation. Blood. 2011; 117 (22): 5850-6.
[iii] Marshall JK et al. Postinfectious irritable bowel syndrome after a food-borne outbreak of acute gastroenteritis attributed to a viral pathogen. Clin Gastroenterol Hepatol. 2007; 5 (4): 457-60.
[iv] Zanini B et al. Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak. Am J Gastroenterol. 2012; 107 (6): 891-9.
[v] Monini M et al. Occurrence of two Norovirus outbreaks in the same cafeteria in one week. New Microbiol. 2019; 42 (3): 156-160.
[vi] Guix S et al. Final consumer options to control and prevent foodborne Norovirus infections. Viruses. 2019; 11 (4). Pii: E333.
[vii] Potera C. Pesticide spraying may spread norovirus. Environ Health Perspect. 2013; 121 (5): a148.
[viii] Jack S et al. Norovirus contamination of a drinking water supply at a hotel resort. N Z Med J. 2013; 126 (1387): 98-107.
[ix] Ahmed SM et al. A systematic review and meta-analysis of the global seasonality of Norovirus. PLoS One. 2013; 8 (10): e75922.
[x] McFarlin BK et al. Baker's yeast beta glucan supplementation increases salivary IgA and decreases cold/flu symptomatic days after intense exercise. Journal of Dietary Supplements. 2013; 10 (3): 171-83.
[xi] Read SA et al. The role of zinc in antiviral immunity. Adv Nutr. 2019; 10 (4): 696-710.
[xii] Rubey RN. Could lysine supplementation prevent Alzheimer’s dementia? A novel hypothesis. Neuropsychiatric Disease and Treatment. 2010; 6: 707-10.
[xiii] Iyer N, Vaishnava S. Vitamin A at the interface of host-commensal-pathogen interactions. PLoS Pathog. 2019; 15 (6): e1007750.
[xv] Yamshchikov AV et al. Vitamin D for treatment and prevention of infectious diseases: a systematic review of randomized controlled trials. Endocrine Practice. 2009; 15 (5): 438-49.
[xvi] Long KZ et al. Vitamin A supplementation has divergent effects on norovirus infections and clinical symptoms among Mexican children. J Infect Dis. 2007; 196 (7): 978-85.
[xvii] Chen P et al. Association of vitamin A and zinc status with altered intestinal permeability: analyses of cohort data from northeastern Brazil. J Health Popul Nutr. 2003; 21 (4): 309-15.
[xviii] Hall JA et al. The role of retinoic acid in tolerance and immunity. Immunity. 2011; 35 (1): 13-22.
[xix] Lee H, Ko GP. Antiviral effect of vitamin A on norovirus infection via modulation of the gut microbiome. Sci Rep. 2016; 6: 25835.
[xx] Lee H, Ko GP. New perspectives regarding the antiviral effect of vitamin A on norovirus using modulation of gut microbiota. Gut Microbes. 2017; 8 (6): 616-620.
[xxi] Kearns MD et al. The impact of vitamin D on infectious disease: a systematic review of controlled trials. Am J Med Sci. 2015; 349 (3): 245-262.
[xxii] Huaman JW et al. Effects of prebiotics vs a diet low in FODMAPs in patients with functional gut disorders. Gastroenterology. 2018; 155 (4): 1004-1007.
[xxiii] Crost EH et al. Production of an antibacterial substance in the digestive tract involved in colonization-resistance against Clostridium perfringens. Anaerobe. 2010; 16 (6): 597-603.
[xxiv]Kennedy MJ, Volz PA. Ecology of Candida albicans gut colonization: Inhibition of Candida adhesion, colonization, and dissemination from the gastrointestinal tract by bacterial antagonism. Infect Immun. 1985; 49 (3): 654-63.
[xxv] Flanagan PK et al. Killing of Escherichia coli by Crohn’s disease monocyte-derived macrophages and its enhancement by hydroxychloroquine and vitamin D. Inflamm Bowel Dis. 2015; 21 (7): 1499-510.
[xxvi] Scricciolo A et al. Vitamin D3 versus gliadin: a battle to the last tight junction. Digestive Diseases and Sciences. 2018; 63 (1): 1-3.
[xxvii] Plummer S et al. Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of C. difficile diarrhoea. International Microbiology. 2004; 7: 59-62.
[xxviii] Roberts JD et al. An exploratory investigation of endotoxin levels in novice long distance triathletes, and the effects of a multi-strain probiotic/prebiotic, antioxidant intervention. Nutrients. 2016; 8 (11): 733
[xxix] Lei S et al. High protective efficacy of probiotics and rice bran against human norovirus infection and diarrhea in gnotobiotic pigs. Front Microbiol. 2016; 7: 1699.
[xxx] Sindhu KN et al. Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2014; 58 (8): 1107-15.
[xxxi] Bhutta ZA et al. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr. 2000; 72 (6): 1516-22.
[xxxii] Zhou Q et al. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut. 2019; 68: 996-1002.
[xxxiii]Mattar R, de Campos Mazo DF, Carrilho FJ. Lactose intolerance: diagnosis, genetic and clinical factors. Clin Exp Gastroenterol. 2012; 5: 113-121.
[xxxiv]Fasano A. Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiol Rev. 2011; 91(1):151-75.
[xxxv] Nielsen et al. Magnesiumsupplementation improves indicators of low magnesium status and inflammatory stress in adults older than 51 years with poor quality sleep. Magnes Res. 2010 Dec; 23 (4): 158-68
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