There is lots of evidence emerging that the underlying poor metabolic and immune health status of people increases their chance of contracting COVID-19 and impacting the severity of their symptoms. This article addresses those and proposes solutions.
A new study (Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area) published on 22nd April characterises the comorbidities and clinical outcomes of 5,700 patients hospitalised because of COVID-19 in the New York area.
The authors found that 94 per cent of the patients had a chronic health problem, and 88 per cent had two or more. The three most prevalent conditions were hypertension (56.6 per cent), obesity (41.7 per cent), and diabetes (33.8 per cent).
So there is no better time to be aware of what can be done to improve metabolic health and therefore immune health. Isolation is a huge opportunity to take action, commit to personal health and lower risk of suffering.
The virus won’t disappear, but people can do things now that will support their metabolic health and immune system.
How do we measure metabolic health?
There are five measures of metabolic health or ill health. These are Blood Pressure; Blood Glucose HbA1c; Triglycerides, HDL; and waist circumference.
The following are the levels considered as markers of metabolic syndrome.
- Blood Pressure - Over 120/80
- Blood Glucose HbA1c - Over 5.7 mmol
- Triglycerides - Over 1.7 mmol/L
- Waist circumference at belly button - Over 102cm in men, over 88cm in women
- HDL - Under 1 mmol/L
You don't need all five to be in the ‘wrong place’, just one will mean you are suffering from 'metabolic disfunction' and three is ‘Metabolic Syndrome’.
What causes ‘Metabolic Syndrome’?
The primary driver of metabolic syndrome is Insulin Resistance or Hyperinsulinemia.
Before we get to insulin resistance, I need to explain how metabolism works.
Most of the cells in your body contain an 'energy convertor' called mitochondria. Inside the mitochondria fats or glucose are converted into Adenosine Triphosphate (ATP) that then powers our bodies.
Triglyceride is an ester derived from glycerol and three fatty acids. Triglycerides are the bodies method for storing energy in fat cells (adipocytes)
When the body requires fatty acids as an energy source (in the absence of glucose in the bloodstream) hormones such as glucagon signal lipolysis.
During lipolysis, triglycerides are hydrolyzed into glycerol and three fatty acids.
The glycerol component of triglycerides can be converted into glucose.
The glucose is converted to pyruvate.
If there is glucose in the cell already this will be converted to pyruvate.
Pyruvate is taken into the mitochondria and converted to Acetyl-CoA.
This then enters the citric acid or Krebs cycle and through oxidative phosphorylation creates adenosine triphosphate or ATP.
When we consume, digest and absorb carbohydrates they are converted to 'sugar' (e.g. glucose, lactose, fructose) and it is used for energy or stored as fat.
When we consume, disgust and absorb fats they are converted to triglycerides, and either used for energy or stored as fat.
When we consume both together, the fat is sent to ‘storage’ and the glucose is used first as it is more toxic. The body wants to keep the amount of sugar in our bloodstream at a set level of about 4g in total.
If there is more sugar in the bloodstream than you can burn immediately the liver tells the pancreas to secrete insulin.
Insulin tells cells to accept more glucose for quick energy. This glucose is stored as glycogen in the muscles and liver.
But the liver and muscles can only hold so much glucose – about 650g. Once your stores of glycogen are full more insulin is produced to squeeze more glucose into cells. When your cells can't fit any more glucose in then your liver combines the glucose with fats to make to triglycerides and deposits the fat into your subcutaneous fat cells.
Depending on your genes, either the fat cells get bigger or we make more fat cells or both. Until we reach a personal fat threshold and the fat gets deposited as visceral adipose tissue around the internal organs.
Some genetic types cannot produce many subcutaneous fat cells, as the fat then goes straight to the internal organs, these people can be thin on the outside, fat on the inside.
When the insulin your body secretes to control blood sugar is no longer working and is just creating more and more visceral fat, it is resistant to insulin.
Blood glucose levels rise (hyperglycaemia), blood vessels constrict (hypertension) and type 2 diabetes ensues.
Not all people that are obese get diabetes, and not all people with type 2 diabetes are obese. Other signs of insulin resistance are skin tags, acanthosis nigricans (pigment in the skin getting darker) and oedema.
Metabolic Syndrome is commonplace.
Only 12% of US Adults are considered Metabolically Healthy i.e. not suffering 3 of the signs of metabolic syndrome. And there is a big age skew.
In the 20 - 39 year age bracket only 23.3% are healthy; in the 40 - 59 year bracket only 9% are healthy, and in the over 60s only 2.1% are healthy.
Australians tracking not far behind.
Coronavirus and hypertension
Coronavirus enters specific cells (pneumocytes) in the lungs through Angiotensin-converting enzyme 2 (ACE2) receptors. Smoking and metabolic syndrome increase no. ACE2 receptors.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) used for hypertension (a symptom of metabolic syndrome) increase ACE2 receptors.
According to some experts COVID-19 attaches to the cell’s surface via the ACE-2 protein and ARBs increase the expression of the ACE-2 protein in the body as many as three to five times.
Immune System and Metabolic Health
5 cytokines & growth factors important in viral infection: Interferon signalling; TH1 pathway; IL-2 signalling; EIF2 signalling; and Toll-like receptor signalling.
I won't go into what these are but I will say, in people with metabolic syndrome these are impaired compared to healthy subjects.
Furthermore, glycation, caused by excess glucose, interferes with Natural Killer Cell function. People with type 2 diabetes are prone to increased glycation because of their lack of ability to handle glucose.
Many experts believe that the majority of cardiovascular disease is caused by type 2 diabetes, diagnosed or not.
Reverse metabolic syndrome and support your immune system
Step One: Reduce carbohydrate consumption, as close to zero as you can.
The glycaemic response to, (not the carbohydrate content of food) common carbohydrate food:
Cornflakes: 100g equivalent to 112g of table sugar
Chocolate Rice Crispies: 100g equivalent to 98g of table sugar
Raisins: 100g equivalent to 68g of table sugar
White bread: 100g equivalent to 49g of table sugar
Brown bread: 100g equivalent to 42g of table sugar
Basmati Rice: 100g equivalent to 26g of table sugar
Boiled potato: 100g equivalent to 24g of table sugar
Baked French fries 100g equivalent to 20g of table sugar
Banana: 100g equivalent to 18g of table sugar
Apple juice: 100ml equivalent to 17g of table sugar
Boiled spaghetti: 100g equivalent to 15g of table sugar
The effect of reducing carbohydrate consumption:
• Lowers Triglycerides
• Lowers Blood Pressure
• Lowers visceral fat
• Lowers HbA1c
• Increases HDL
All measures of metabolic health. But it also
• Increases LDL
• Increases insulin sensitivity
• Increases T-cell function
• Increases Natural Killer Cells
• Lowers sleep apnea (caused by visceral fat in the tongue)
Important to know if you have type 2 diabetes especially.
Step Two: Avoid Toxins
Unfortunately, our supermarkets are full of 'food like' products that are actually very bad for us.
Big food company marketing, political lobbying and propaganda have programmed us into believing they are safe when they are not. They are at best poor nutrients, and at worst terribly toxic.
1) Refined oils - AKA vegetable oil
These synthesised oils (cottonseed, canola, safflower, corn, rice, soybean) - created industrially by at least 11 processes to dissolve, bleach, hydrogenate and deodorise from a grey seed ooze into a 'shelf stable' golden liquid - was originally a byproduct of the cottonseed industry and originally used as machine lubricants and oil lamps, until some bright spark realised they could fatten animals using it as part of their feed.
Proctor & Gamble then ‘jumped the shark’ (50 years before the FDA was founded) and created ‘Crisco’ for humans as a lard substitute, followed by margarine, and hydrogenated (liquid) oil.
If that's not enough, these 'refinery fats' are high in very unstable polyunsaturated fatty acids (PUFAs). These predominantly 'Omega - 6' fats have multiple weak links in their molecular chains that oxygen loves to bind to. When we heat these oils they become even more oxidated and transform into even more toxic molecules.
This 'lipid peroxidation' creates poisons such as 4-Hydroxy-nonenal (4-HNE), Malondialdehyde (MDA), Oxidised Linoleic Acid Metabolites, Acrolein, and Carboxyethylpyrrole. You don't need to know what they are, just what they do.
(Acrolein, for example, is one of the toxins in cigarettes. Acrolein content in 150g of french fries cooked in seed oil is the equivalent to smoking 17-26 average cigarettes.)
These chemicals are cytotoxic, genotoxic, mutagenic, carcinogenic, atherogenic, pro-inflammatory and thrombogenic.
That means they lead to heart disease, obesity, cancer, dementia, non-alcoholic fatty liver disease and metabolic syndrome.
Worse still, if we don't use them immediately for energy (which causes mitochondrial dysfunction) they are stored as triglycerides in our fat cells. Only to be released during fat loss, causing more inflammation and more insulin resistance.
2) Refined Carbs - AKA sugar
Refined carbohydrate is a moniker for a category of sugar molecules.
Table sugar or sucrose is 50/50 glucose and fructose, fruit is predominantly fructose, milk contains lactose, starch too converts to glucose.
All carbs are sugar, but sugars with different names. There are approx. 58 different names for sugar that can be included in an ingredient list.
High levels of blood sugar affect our innate immune system. Insulin resistance, as already discussed, creates a state of hyperglycaemia.
Hyperglycaemia mimics a state of constitutively active pro‐inflammatory condition in cytokines such as neutrophils, leading to reduced response to external stimuli.
Hyperglycaemia also activates protein kinase C, and this further inhibits neutrophil migration, phagocytosis, superoxide production and microbial killing. All important functions of the immune system.
Hyperglycaemia can also induce Toll-like receptor expression and inhibit neutrophil function and apoptosis.
Plants cannot run away from danger like animals. So, they evolved complex chemical methods of discouraging predators from consuming them, and especially their progeny we call seeds.
These chemicals are grouped together and called Lectins: Agglutinins, Prolamins, Saponins, and Digestive Enzyme Inhibitors. Each one designed to protect against animals, insects, bacteria and fungi.
Grains are seeds. The lectins in them cause intestinal permeability (leaky gut) and are the precursor for many autoimmune issues.
Gluten, the lectin in wheat is well known for causing leaky gut. It causes an autoimmune disease called Celiac Disease.
Zonulin is stimulated by gliadin in the wheat and opens the tight junctions in the gut lining. A leaky gut allows larger ‘foreign’ molecules to enter the bloodstream that shouldn’t be there, causing an immune response and inflammation.
Barley, rye, oats, sorghum, rice and corn grains also contain prolamins (Hordein, secalin, avenin, kafirin, orzenin and andzein), and should therefore be avoided. As much for their carbohydrate content as their ability to weaken our immune system.
Anything that creates inflammation as a response to an immunological attack depletes our ability to fight pathogens of a bacterial or viral nature.
4) Ultra-processed (junk) food
If you look at the ingredients on the back of most ‘food-like’ items bought in a supermarket you’ll notice they contain one, two or all three of the above toxins: veg oil, refined flour (wheat, corn, rice, soy) and added sugars.
70% of the calories in the US diet are ultra-processed foods.
5) Other Common Anti-nutrients
Legumes: Prolamins and digestive enzyme inhibitors
Phytates: Phytic acid salts found in plants bind the calcium, iron, zinc, magnesium, potassium making it unavailable to digestion causing mineral deficiencies. They also inhibit digestive enzymes for protein absorption. So, excess phytates also make the gut leaky, prevent nutrient absorption and harm the microbiome.
Oxalates: Oxalic acid salts found in plants such as spinach and kale binds the calcium making it unavailable to digestion causing mineral deficiencies. Calcium oxalate is what a kidney stone is made from.
Saponins and Glycoalkaloids: Have detergent-like qualities and also affect the resilience of the gut membrane. Found in grains, pseudo-grains and plants in the nightshade family e.g. tomatoes, peppers, capsicum, zucchini, potatoes, aubergine, even goji berries.
Nightshades: Also have agglutinins which increase gut permeability and coagulate red blood cells.
Step Three: Eat immune-supporting food
1) Essential & Complete Amino Acids from animals
There are 9 essential amino acids: Valine, phenylalanine, histidine, lysine, methionine, tryptophan, isoleucine, threonine and leucine. Essential because we cannot manufacture them inside the body. Arginine is another amino acid considered conditionally essential as we don’t synthesise it very well.
When bound together we categorise these amino acids as protein.
- Leucine plays a key role in stimulating muscle protein synthesis (making muscle, including the heart).
- Serotonin is made from tryptophan. Serotonin is our “feel-good” neurotransmitter. The amino acid is converted into serotonin primarily in our gut microbiome.
- Epinephrine (Adrenaline) is derived from tyrosine and helps us activate our fight-or-flight response.
- Creatine is synthesized from three amino acids; glycine, arginine and methionine and supplies ATP energy molecules to our muscles.
- Histamine is derived from histidine and is released during an allergic reaction and required for the synthesis of hemoglobulin.
- Carnitine is synthesised in the liver from lysine and methionine. It transports fat into mitochondria for oxidation. Improves hypertension, oxidative stress, nitric oxide, and inflammation and improves fasting glucose levels.
- Glutathione is synthesised from cysteine, glutamate, and glycine. It is the bodies Master antioxidant. Increasing longevity, preventing illness, reducing the risk of chronic disease, strengthening the immune system and protecting against oxidative stress and inflammation.
Amino Acids in beef (mg per 1000mg)
Total 745 mg
The Recommended Daily Allowance (RDA) 0.8g per Kg of lean body weight (what you weigh minus the fat) per day for ‘homeostasis’. That is to maintain the what is lost naturally.
However, 1 – 3.5g / Kg/day could be better for different cohorts.
For example, if your goal is body composition or strength, or you exercise or sport creates a lot of oxidative dame, inflammation or tissue damage you might want to increase the amount you consume to 2g / kg per day.
If you are over 60, your stomach acid and protein enzymes are likely to be sub-optimal, so the amount of protein digested isn’t as easily absorbed. To prevent sarcopenia you also might want to increase the amount you consume to 2g / kg per day and or supplement with protease enzymes, or hydrochloric acid.
The protein sources I recommend are Grass-finished ruminants (beef, lamb, venison), pasture-raised (pork, chicken, duck), bone broth & offal not just the muscle meat, esp liver.
Cold Water Fish – Sardines, Mackerel, Anchovies, Salmon and Herring. Cheese and butter, especially from Beta casein A2milk (Guernsey, Sheep, Buffalo, Goat).
2) Healthy fats
Most natural fats, fats found in nature, are a mixture of saturated and monounsaturated fatty acids. There is very little polyunsaturated fat (PUFA) in nature.
Saturated fat is very stable because there are no available carbon bonds to oxidise. Monounsaturated fats have a single carbon bond and are less stable. PUFAs are highly unstable, as mentioned earlier.
Most people are frightened of fat because of some very poor science pre-1970. That science wrongly blamed saturated fat and dietary cholesterol for causing heart disease.
But not only is cholesterol not a fat, it is a steroid, but our bodies make it. If we consume it, our bodies make less.
Cholesterol is the precursor to the production of all steroid hormones in the body, is a component of the cell membranes, and 25% of our brains are made from it.
Lowering cholesterol, or avoiding saturated fats is antithetical to optimal human health.
To support your immune system you need to have optimal levels of fat and cholesterol circulating in your body. Those fats in the form of triglycerides are used by cells for energy in a clean, more efficient way. The cholesterol is used in the repair and defence of our cells.
The triglycerides and cholesterol are carried in vehicles in the blood called lipoproteins. Lipoproteins are named for where they were produced and how dense they contain triglycerides and cholesterol.
Low-density lipoproteins aka LDL have been villainised as bad actors in cardiovascular disease. But LDL is protective and at the core of protecting us against invaders like virus.
Cholesterol is ‘found at the scene’ of arterial blockage, not because it caused the ‘accident’ but because it was called on to repair the damage. Blaming cholesterol for cardiovascular disease is like blaming LiquiMoly for bursting your car radiator.
Likewise, LDL is required in the ‘Acute phase response' of an infection.
LDL is part of our innate immune system. Signalling proteins called pro-inflammatory cytokines call for help, the liver and lipolysis increases VLDL production. VLDL drops some of its load and becomes LDL. LDL sticks around patrolling. LDL binds to pathogen and marks them for ‘death’.
Macrophages then see the signal and act as judge, jury and executioner.
LDL doesn’t just carry cholesterol and triglycerides either. It carries fat-soluble vitamins A, D, E and K which are vital antioxidants. They also carry CoQ10 vital for the production of energy by the mitochondria.
If you have high LDL your doctor may have prescribed a statin that lowers. You may need to discuss with your physician the short-term benefits of deprescribing these.
High-density lipoproteins (HDL) are produced by the liver to scavenge/manage the LDL, so it is important for them to be high.
Being infected with any virus lowers cholesterol as it is depleted through it the signalling and oxidation.
In order to ‘supplement’ our needs for cholesterol, we should consume mainly fats that are solid at room temperature (Lard, Tallow, Butter, Ghee) or oils high in saturated fats (coconut, avocado, olive oil).
Most people don’t need to supplement fat as we carry plenty around with us stored for energy.
Foods high in cholesterol Eggs, cheese, shellfish, grass-fed beef/offal, sardines and yoghurt
Eggs are one of natures most nutrient-dense foods. If you are not tolerant eat plenty.
Apart from being very satiating, they contain great amounts of Vitamins A, B2, B5, B12, D, and E; minerals like Calcium, Iron, Magnesium, Phosphorous, Potassium, Sodium, Zinc, Copper, Manganese, Selenium; plus Folate, Iodine and Choline. They contain 18 amino acids inc the 9 essential ones (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine, plus cysteine, glycine, alanine, arginine, glutamic acid, proline).
Step Four: Fasting
Whether that is simply decreasing the timeframe in the day in which you eat, or not eating for longer periods of up to 36 hours depends on your body’s ability to use the stored energy (fat).
Reducing the frequency of eating and leaving longer periods of not consuming energy, will decrease insulin secretion, and enable glucagon, the hormone responsible for turning on fat burning.
Time-restricted eating can be simply moving from a current eating window of 14 hours (7am-9pm) to a window of 8 hours (8am-4pm or 10am-6pm).
Once your body is starved of insulin you can utilise the stored energy. The 650g of glycogen I mentioned earlier will provide 2600 calories alone. Every kilo of stored fat can be converted to 9000 calories.
Many 'fat-adapted’ people can go days without eating very much at all. The stored energy in fat cells is released and converted to ketone bodies and the mitochondria will burn acetyl-CoA made from those ketones. This is ‘ketosis’. You do not (maybe should not) consume much dietary fat, if you are able to draw down those fats stored.
The effect of fasting:
• Lowers Triglycerides
• Lowers Blood Pressure
• Lowers visceral fat
• Lowers HbA1c
• Increases HDL
• Increases Natural Killer Cells.
Step Five: Vitamins & Mineral supplements
If deficient, or obtaining insufficient levels from good quality, fresh, organic, local produce.
Vitamins: A, C, E & K.
Minerals: Zinc, Magnesium, Copper and Selenium
Step Six: Lifestyle modifications
Vitamin D can be obtained best from sun exposure as UVB converts cholesterol in the epidermis to vitamin D.
Vitamin D is a secosteroid hormone with various skeletal and non-skeletal effects including regulation of innate and adaptive immune responses.
Vitamin D decreases expression of pro-inflammatory-cytokines and increases the production of antiviral and antibacterial proteins, suggesting an important role in antiviral innate adaptive immunity.
Vitamin D is also involved in renin-angiotensin system regulation, which is regulated by the entry of the SARS-Cov-2 virus into cells via the ACE2 receptor, leading to cytokine storms, with subsequent fatal respiratory distress syndrome.
Levels of vitamin D in hunter-gatherer populations, for example, the people of the Masai, is around 40 - 50 ng/ml.
In a study in April, (Vitamin D supplementation could possibly improve clinical outcomes of patients infected with coronavirus 2019 Mark Alipio) 212 people with COVID-19 were tested for vitamin D.
In 'mild cases', 96% had more than 30 ng/ml. In 'Standard cases - critical cases' 90% less than 30 ng/ml. 50% of those below 20 ng/ml.
The risk ratio for dying of COVID-19 with >30 ng/ml <1x, but <30 ng/ml 12.5x, and <20 ng/ml 19.1x.
Even when corrected for age, sex and comorbidity a level of <30 ng/ml 7.6x, and <20 ng/ml 10.1x.
The risk of getting cancer from smoking is between 10x and 20x. So Vitamin D deficiency is at that level of risk.
Most people are deficient in D.
In the USA 70% 'insufficient' (<30 ng/ml) / 28% 'deficient' (<20 ng/ml).
It is even more likely if you are elderly, obese, dark-skinned or living in northern latitudes.
People with darker skin need more exposure to convert sufficient vitamin D. In northern latitudes working indoors that further exacerbates the challenge.
In the USA, over the period 1988-94 and 2001-2004, levels of vitamin D dropped from 50% >30 ng/ml to 30% in white people, but from 12% to <5% in black people. And that was 16 years ago.
People in Italy are renowned for having low levels of vitamin D, especially older females.
Italy has one of the worst vitamin D deficiency rates in Europe
A study of Italian women aged 60-80 found values of 5 ng/ml in 27%, and lower than 12 ng/ml in 76% of those tested.
If you want more information the benefits of sun exposure Vitamin D and the scientific calcium dogma: understanding the 'Panacea' of the sun.
If you cannot get enough sun exposure then supplementing with vitamin D rich foods (animal protein, fish and eggs) or supplements.
Although the RDA is around 600-800IU, a person of lighter skin colour can 'make' 20,000IU in around 20 minutes of full sun exposure.
So 4,000 - 10,000IU per day would build up reserves, depending on starting point.
As well as getting vitamin D from sunshine we also produce nitric oxide, which lowers blood pressure.
7 to 8 hours of good quality sleep is required for the body to have the time to shut down the calls on resources and allow those resources to be mobilised to the immune system. Sleep is immune therapy in its own right.
Stomach Acid kills the virus. If you have low stomach acid (common in the elderly) or are being treated for stomach acid problems you may be more susceptible. If you are using proton pump inhibitors that lower acid you may need to discuss with your physician.