Dr Murtaza Chishti
An unknown percentage of the population with Covid-19 has no symptoms while 85% have mild diseases. Some need hospitalization and others end up in the ICU. The question is, why do some do well and others donâ€™t? Whatâ€™s the basis for it?
Four conditions are well known to increase the risk of severe Covid-19: Obesity, Diabetes, Heart Disease and High Blood pressure. Those with diabetes or heart disease have a 20% chance of landing in the ICU. The risk increases sharply above 60 years of age. It is not just the age, however. As we get older, we also get sicker. We have seen many young people succumb while many older people recover uneventfully. Is there anything common among those who get into trouble? Turns out, it is metabolic health. You could be a metabolically healthy elderly person with low risk or a metabolically unhealthy young person with high risk.
What does it mean to be metabolically healthy?
There are five criteria for metabolic health:1) Blood Sugar, 2) HDL Cholesterol or â€œgood cholesterolâ€, 3) Serum Triglycerides, 4) Blood Pressure, andÂ 5) Obesity.
Having any two of these in the unacceptable range constitutes Metabolic Syndrome and indicates poor metabolic heath. Metabolic syndrome not only increases the chances of developing diabetes and heart disease but also impairs the bodyâ€™s ability to fight infections (Immunity). The crucial thing here to understand about metabolic syndrome is its root cause: Insulin Resistance!
The hormone insulin is essential to life. It enables the body tissues to optimally utilize glucose. When body tissues fail to respond to insulin normally, it is called insulin resistance. The body responds by producing more insulin with the result the insulin levels in the blood remain high.Â Persistently high insulin level (hyperinsulinism) leads to metabolic syndrome.
The main cause of hyperinsulinism is a high carbohydrate diet. Table sugar is an example of refined carbohydrate. Simple sugars combine to make long chains called complex carbohydrates like starch found in large quantities in grains like rice, wheat, corn and vegetables like potatoes. Starch is changed in the body to glucose, a simple sugar. To give you an idea, 100gm boiled rice is equivalent to 5 teaspoons of sugar.Â
Fortunately, restricting carbohydrates reverses insulin resistance and hence metabolic syndrome.
In a study in US adults, only 2% over 60 years were metabolically healthy. The corresponding figure for those younger than 40 is 23%. If you have not been paying attention, there is a high chance that you may not be metabolically healthy. There are several physical signs which may point to poor metabolic health.
1)Â Â Obesity, especially abdominal obesity assessed by waist circumference. A waist circumference of more than 40 inches in males and more than 35 in females indicates excess visceral fat.
2)Â Â Moderate to severe acne in young people
3)Â Â Increased skin pigmentation in the neck, face, axillae or groin
4)Â Â Skin tags
5)Â Â Eczema and
6)Â Â Premature male pattern baldness.Â
Corona, Immunity and Insulin Resistance
Virus laden particles settle in the throat and a sore throat is an early sign of Covid-19. If the body restricts the virus here, the illness is likely to be mild. If the virus manages to invade the windpipe, it spreads to the lungs and beyond causing a severe or fatal disease.
Whether or not the virus spreads depends on both the virusâ€™s virulence and hostâ€™s immunity.
The virus enters the cells through an â€˜entry pointâ€™ on the covering of the cells called ACE2 (a sort of entry door) found in the cells of the air passages, lungs, heart and liver. Metabolic syndrome and smoking increase the number of these entry doors and increase susceptibility to infection.
After the virus enters the cells, we depend on the immune system to kill the virus. Diabetes and insulin resistance weakens many different, cellular and chemical components of our immune system.
In the UK, 35% of patients who died were diabetic.
Low carbohydrate diet is the answer to insulin resistance and metabolic syndrome.
On a low carb diet, insulin resistance and blood sugar level can improve in a matter of days or weeks. More than half the patients can even reverse insulin resistance over a couple of years.
The Good Cholesterol(HDL) goes up triglycerides go down. This reduces the risk of heart disease. Though the so called â€œbad cholesterolâ€( LDL) goes up , that is not a problem. 16 research studies showed better survival with higher LDL, busting the myth that cholesterol causes heart disease. It is only the cholesterol damaged by high blood sugar that causes Cardiovascular disease. Research shows that a high Total Blood Cholesterol may protect against infection. Cholesterol levels drop during Covid19 and return to normal as the patient recovers.
Obesity increases the risk of getting Coronavirus pneumonia three and a half times. Visceral obesity, which refers to fat in and around abdominal organs, poses the most risk. One extra kilo of visceral fat, doubles the risk of diabetes in men and quadruples it in women. When we lose weight with low carb diet, visceral fat is lost first. So a modest weight loss can improve metabolic health.
Fat also enlarges the tongue, leading to obstructive sleep apnea (OSA), breathing problem during sleep. OSA increases the risk of landing in the ICU 5 times. Weight loss also cures OSA.
There is evidence from 31 published studies that confirms that low carb, rather than low fat diet is effective in weight loss.
Weight loss improves immunity as does fasting.
High Blood pressure is associated with 6% mortality in Covid-19.Contrary to popular belief, high blood pressure is not caused by increased salt intake. As mentioned before, sugar causes insulin resistance and high blood insulin levels. Insulin makes the kidneys retain excess salt leading to high blood pressure. When insulin levels drop, kidneys get rid of excess salt and blood pressure returns to normal. Except in certain circumstances, restricting salt may not be a good idea.
It is clear that low carb diet improves metabolic health and strengthens immune system, certainly an advantage during a pandemic.
As you reduce carbs you must increase fats and proteins in the diet. Meat, eggs, Ghee, butter and nuts are ideal. There is plenty of evidence in literature that saturates fat in these foods is not only safe but enhances health. It is essential to exclude seed oils as they have been shown to cause serious health problems.
A healthy diet is essential for a strong immune system that enables us to fight infection, be it Coronavirus or anything else!
Being metabolically healthy is a key to a healthy immune system.