Why are Laos and its neighbors faring so well during the COVID-19 pandemic? A consideration of diet factors

Laos had COVID-19 cases very early in this pandemic. Laos neighbors China and has many commercial ties to it. Yet Laos has had only 19 known cases and no deaths. Vietnam and Cambodia, which border Laos to the south and east, have had 387 cases total but also no deaths. And Thailand, at around 2500 known cases, has only seen 40 deaths. What is different about the Indochinese peninsula that could be protecting them from the case numbers  and death rates being experienced in Italy, Spain, and the USA?

I will leave the specialized research into biomedicine to the experts right now and focus on dietary differences. Food choices often make an enormous difference in health issues, and I don't see them getting much attention right now.

What do people eat in Laos? The main starches appear to be rice (especially glutinous rice) and fruit (especially papaya and banana). The primary dietary fats appear to be palm oil and coconut. Stir frying at a high temperature in a wok, grilling, and deep frying are the main ways in which food is cooked. Typical condiments include fish sauce, fermented shrimp paste, and soy sauce. While meals are often accompanied by many fresh greens, Laotians also eat sweet snacks throughout the day. Galangal (a close relative of ginger) is a heavily-used spice, along with garlic, shallots (a type of onion), and lemongrass. Green tea and coffee are common beverages.

How does the Laotian diet differ from the Italian diet? Ginger is not very popular in Italy. The main dietary starch is wheat. Green tea tends to be reserved for weight loss and fighting colds. Wine is commonly consumed. Olive oil is a cornerstone of the Italian diet. A variety of cooking methods is used, but wok usage is rare.

These are just some of the differences between typical Laotian and Italian diets. Which ones could be relevant to COVID-19? I want to point out three differences that I think should be investigated:

1) Ginger/galangal consumption.

Ginger is an anti-inflammatory spice. Ginger has repeatedly been shown to reduce the levels of both interleukin 1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α), cytokines which are involved in the destructive immune reaction to COVID-19. (See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103735/.)

2) Fermented shrimp paste. 

Shrimp shells are a good source of glucosamine, and the fermentation process breaks down the shell and thus makes the glucosamine more bioavailable. As I've discussed before on my blog, glucosamine appears to help protect against developing pneumonia, which I hypothesize is a result of its protecting cartilage cells from attack by the immune system. 

3) Lauric acid and myristic acid intake.

The "tropical oils," i.e., coconut oil and palm oil, contain lauric acid and myristic acid, which can help protect cartilage. (See https://www.oarsijournal.com/article/S1063-4584(18)30141-9/fulltext.) Lauric acid is relatively uncommon outside of coconuts.

Until recently, the Mediterranean diet was touted as one of the heathiest in the world. As seen in the past two months, it did not appear to protect the relatively wealthy countries of Italy and Spain from COVID-19, especially when compared to some financially-challenged countries in southeast Asia. I hope to see more attention paid in the coming weeks to possible dietary factors behind that unexpected outcome.

(My apologies for having almost certainly missed some other important dietary factors that could end up being relevant to the fight against COVID-19. The above is what I have put together from having lived in Europe and the Philippines and read a lot about southeast Asian and European cuisines. I even had an Italian live with our family recently, who made it clear that ginger was not a favorite with her!)