Figure 3: Central role of Nrf2 in the impact of fermented vegetables on COVID-19 severity . SARS-CoV-2 downregulates ACE2, inducing an increased insulin resistance associated with oxidative stress through the AT1R pathway. Fermented vegetables are often made from Brassica vegetables that release glucoraphanin converted by the plant or by the gut microbiome into sulforaphane which activates Nrf2 and subsequently reduces insulin intolerance. Fermented vegetables have a high content of Lactobacillus that can activate Nrf2 and impact the microbiome.