Cabbage and fermented vegetables: from death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

摘要: Large differences in COVID-19 death rates exist between countries and regions of the same country. Some very low rate such as Eastern Asia, Central Europe or Balkans have a common feature eating large quantities fermented foods. Although biases when examining ecological studies, vegetables cabbage were associated with European countries. SARS-CoV-2 binds to its receptor, angiotensin converting enzyme 2 (ACE2). As result SARS-Cov-2 binding, ACE2 downregulation enhances II receptor type 1 (AT1R) axis oxidative stress. This leads insulin resistance, lung endothelial damage, two severe outcomes COVID-19. The nuclear factor (erythroid-derived 2)-like (Nrf2) is most potent antioxidant humans can block AT1R axis. Cabbage contains precursors sulforaphane, active natural activator Nrf2. Fermented contain many lactobacilli, which are also Nrf2 activators. It proposed that proof-of-concept dietary manipulations may enhance Nrf2-associated effects helpful mitigating severity.