Health experts around the globe have been warning of the risk of a pandemic like COVID-19 for years — and they tell us that we can expect similar viruses to break out in the future. Dr. Mark Cucuzzella suggests that our current approach has focused on hiding from this virus and he makes the case that it’s just as important to strengthen our resistance to COVID-19 and future viruses — in other words, healthier lifestyles for healthier immune systems.
Rethinking How We Fight the Virus
As we reopen society and search for medicines that could improve coronavirus outcomes, we should not miss the opportunity to talk about the conditions that have increased our vulnerability to this pandemic in the first place: America’s poor state of health. Some 60 percent of us have one or more diet-related chronic disease. Even before the pandemic, the cost of this poor health was responsible for a staggering amount of the 3.5 trillion dollars spent annually on healthcare in the US. With COVID-19, these underlying diseases, particularly cardiovascular disease, obesity, and diabetes, have accompanied a large majority of severe cases in the US, according to the Centers for Disease Control and Prevention (CDC). Hospitalizations were six times higher, and deaths were twelve times higher, among those with reported underlying conditions compared with those with none reported. We have often blamed the victim for having obesity or other diet-related diseases, but these illnesses now affect up to 80 percent of the world’s population.
Weighing the Evidence
Obesity is clearly emerging as a dominant factor increasing the risk of hospitalization and death from COVID-19. In a recent study on co-morbidities conducted in France, only one in every ten people who ended up in intensive care with COVID-19 were in a healthy weight range. Researchers led by Francois Pattou, the head of Lille University Hospital’s general and endocrine surgery department in France, presented data at a conference showing that about half of the 124 intensive-care patients with COVID-19 in a sample they studied were obese and most of the remaining ones were overweight. It seems inescapable that, to build resilience to COVID-19 and future viruses, we need to talk about better nutrition.
In the United Kingdom, the National Health Service (NHS) reports that over a quarter of fatalities from COVID-19 are accompanied by diabetes. Prime Minister Boris Johnson became convinced that his own obesity contributed to his hospital stay, prompting him to declare, upon launching a probe into the link between obesity and worsened COVID-19 outcomes, “I’ve changed my mind on this [obesity]. We need to be much more interventionist.”
Almost all of these comorbidities — hypertension, diabetes, coronary artery disease, and obesity — have a common root cause, called insulin resistance. Insulin resistance is diagnosed when a person has a spectrum of symptoms, including abdominal obesity, low HDL-cholesterol, high triglycerides, high blood pressure, and high blood sugar. Up to 88 percent of Americans have one or more of these symptoms, according to estimates based on recent data from the National Health and Nutrition Examination Survey (NHNES). This means that only 12 percent of our population is metabolically well. Given that chronic diseases are strongly implicated in poor outcomes for coronavirus patients, we need to take insulin resistance far more seriously.
Just A Spoonful of Sugar
Reducing our consumption of sugar and refined carbohydrates, which together fuel insulin resistance, is an ideal first step. Eating to keep blood sugar low and stable will clearly reduce risk. Recently, the World Health Organization launched a Stay Healthy At Home Campaign, urging adults to limit their sugar consumption to less than six teaspoons a day — the amount of sugar in one small carton of chocolate milk served to school children. Anyone can purchase a continuous glucose monitor to know exactly how foods are affecting blood sugar levels. Junk food is the obvious enemy, even if it can be every quarantiner’s best friend. Yet even these comforting foods can be resisted when replaced by whole, natural foods including filling fats and proteins. It is also critical to focus the diet on foods that are nutrient-dense: meats, eggs, seafood, dairy, vegetables, and low-sugar fruits.
Mapping the Path to Wellness
Many people who aim to achieve good health do so through natural means, such as better nutrition and other lifestyle changes of moving more, sleeping better, and reducing stress. Instead of managing their conditions with pills, they seek to reverse chronic disease through more natural approaches. This strategy, like a vaccine, should provide protection now and for many years to come, and that is essential, since COVID-19 will not be like a blizzard (hitting hard and quickly passing over) but rather like a long hard winter. We all can get healthier and this applies especially to those with metabolic illnesses.
The reality is that we are partially responsible for our fragility to the coronavirus. Each comorbidity you have decreases your physiological reserve. We should be doing a better job in maintaining our health for times when we are under stress. I hope to see a new world where people have the tools to recover their good health and become stronger to fight pandemics such as this one. Right now, we are hoping for a vaccine and medications to pull us out of this pandemic. We are probably in mile 4 now of the 26-mile COVID marathon, but even as the coronavirus eventually abates, the ongoing obesity, diabetes, and metabolic disease pandemics will continue to take their toll on our society. It’s time to take back our health, our own resilience — race for your life instead of running from illness.
Mark Cucuzzella MD, FAAFP, is a Professor of Family Medicine at West Virginia University School of Medicine and a practitioner at the WVU Center for Diabetes and Metabolic Health and Shepherdstown Medical office.By Mark Cucuzzella