While the World Health Organization has put the death rate from novel coronavirus, COVID-19, at 3.4%,1 a study in Nature Medicine put it much lower, at 1.4%.2 The fact is, with many cases going unreported and untested, mild and asymptomatic cases may not be included in official COVID-19 death rate figures, which could skew the death rate significantly, making it appear higher than it actually is.
In Italy, however — the “new” epicenter for COVID-19 — the number of deaths reportedly overtook those in China by mid- to late March 2020.3
As the home to the world’s second-oldest population after Japan, Italy’s elderly population is at increased risk of death from COVID-19, but there’s another factor that also makes you more susceptible to death or serious illness if you contract COVID-19: an underlying health condition, particularly diabetes or high blood pressure.
This is why, if you want to stay healthy in this pandemic, one of the best strategies is to get your underlying chronic conditions under control; even diabetes and high blood pressure can often be reversed via healthy diet and lifestyle.
99% of COVID-19 Deaths in Italy Had Underlying Conditions
According to a study by The Istituto Superiore di Sanità, Italy’s national health authority,4 more than 99% of fatalities from COVID-19 occurred among people who had underlying medical conditions.
The finding came from an examination of 18% of Italy’s COVID-19 deaths, which revealed that only three people who died — or 0.8% — had no underlying conditions. On the contrary, nearly half the victims had three underlying conditions while one-fourth had one or two.5
Further, among the fatalities, 76.1% had high blood pressure, 35.5% had diabetes and 33% had heart disease.6 While the median age of those infected was 63, most deaths occurred in older people, with 79.5 being the average age of those who’ve died. Among those who were under 40 when they died, all had serious underlying health conditions.7
A report of the WHO-China Joint Mission on COVID-19, released in February 2020, similarly found a higher crude fatality ratio (CFR) among people with additional health conditions. While those who were otherwise healthy had a CFR of 1.4%, those with comorbid conditions had much higher rates, as follows:8
- Cardiovascular disease — 13.2%
- Diabetes — 9.2%
- High blood pressure — 8.4%
- Chronic respiratory disease — 8%
- Cancer — 7.6%
Underlying Conditions, Obesity Increase Risk of Poor Outcomes
Another study looking into the impact of co-existing health conditions like high blood pressure, heart disease and diabetes on COVID-19 outcomes found they’re linked to “poorer clinical outcomes,” such as admission to an intensive care unit, a need for invasive ventilation or death.9
The study involved 1,590 laboratory-confirmed hospitalized patients, revealing that people with a chronic condition were 1.8 times more likely to have a poor outcome compared to those with none. This jumped to 2.6 times more likely for those with two chronic conditions.10
The first review of fatal COVID-19 cases in China also found diabetes may be associated with mortality,11 as did a report of 72,314 cases by the Chinese Center for Disease Control and Prevention.12
While the researchers found a mortality rate of 2.3% in the overall population, this rose to 10.5% among people with cardiovascular disease and 7.3% among those with diabetes.13 Likewise, in a Lancet study of 191 patients in China, 48% of those who died from COVID-19 had high blood pressure.14,15
Likewise, the Intensive Care National Audit and Research Centre released a report on 196 patients critically ill with COVID-19.16 Among them, 56 patients had a body mass index (BMI) of 25 to 30, which is classified as overweight, 58 had a BMI of 30 to 40, which indicates obesity, and 13 had a BMI of 40 or higher which is classified as severely obese. Overall, 71.7% of the critical patients were overweight, obese or severely obese.17
This could have serious implications for the U.S., where approximately 45%, or 133 million, people suffer from at least one chronic disease.18 Among them, more than 1 in 10 have diabetes (and another 1 in 3 has prediabetes),19 while 108 million adults have high blood pressure.20 Further, 71.6% of U.S. adults aged 20 and over are overweight or obese.21
Are ACE Inhibitors Part of the Problem?
In another intriguing finding, researchers from the University of Basel in Switzerland noted that in three studies of patients with COVID-19, the most frequent underlying conditions — heart disease, diabetes and hypertension — are those often treated with angiotensin-converting enzyme (ACE) inhibitors.22 Writing in The Lancet Respiratory Medicine, they explained:
“Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARS-CoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels.
The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs). Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2.”23
In short, the ACE2 enzyme is beneficial in that it promotes tissue regeneration, and ACE inhibitors and ARBs (as well as ibuprofen) increase the formation of ACE 2. The problem is that coronavirus binds to ACE2 and uses it to enter cells, where it then multiplies. “For that reason,” study author Michael Roth said in a news release, “we suggest further research into the use of these drugs in COVID-19 patients.”24
Targeting Insulin Resistance Is Key
The likely common denominator for these diseases is our old nemesis, insulin resistance, in response to a high-carbohydrate and processed food diet. Insulin resistance not only contributes to these diseases but also impairs immune function. So, if your fasting blood sugar is over 100 it would be highly prudent to make diligent efforts to get that under control.
As your insulin and leptin levels rise, it causes your blood pressure to increase. Eventually, you may become insulin and/or leptin resistant. Likewise, Type 2 diabetes is a disease of insulin resistance resulting in high blood sugar.
When your body is insulin resistant,25 the cells in your body do not respond well to insulin, which lowers their ability to use glucose from the blood for energy. The pancreas secretes more insulin, trying to overcome the cells’ weak response in their attempt to keep blood glucose levels in a healthy range.
As noted by Dr. Sandra Weber, president of the American Association of Clinical Endocrinologists, in The New York Times, “We know that if you do not have good glucose control, you’re at high risk for infection, including viruses and presumably this one [COVID-19] as well … [improving glucose control] would put you in a situation where you would have better immune function.”26
What and When to Eat to Beat Insulin Resistance
With regard to insulin resistance, research shows intermittent fasting promotes insulin sensitivity and improves blood sugar management by increasing insulin-mediated glucose uptake rates.27 This is important not only for resolving Type 2 diabetes but also high blood pressure and obesity.
Time restricted eating, i.e., the restriction of eating only during a six- to eight-hour window, mimics the eating habits of our ancestors and restores your body to a more natural state that allows a whole host of metabolic benefits to occur.28 While there are a number of different intermittent fasting protocols, my preference is fasting daily for 18 hours and eating all meals within a six-hour window.
If you’re new to the concept of time-restricted eating, consider starting by skipping breakfast and having your lunch and dinner within a six-hour timeframe, say 11 a.m. and 5 p.m., making sure you stop eating three hours before going to bed. It’s a powerful tool that can work even in lieu of making other dietary changes.
In one study, when 15 men at risk of Type 2 diabetes restricted their eating to a nine-hour window, they lowered their mean fasting glucose, regardless of when the “eating window” commenced.29
What you eat is also important. I recommend adopting a cyclical ketogenic diet, which involves radically limiting carbs (replacing them with healthy fats and moderate amounts of protein) until you’re close to or at your ideal weight, ultimately allowing your body to burn fat — not carbohydrates — as its primary fuel.
Key Steps to Getting — and Staying — Healthy
While many people — young and old alike — are facing Type 2 diabetes, obesity and high blood pressure, these conditions can be turned around, and in so doing you’ll significantly reduce your risk of becoming seriously ill from COVID-19.
Along with intermittent fasting and a cyclical ketogenic diet, the tips that follow will help you prevent and reverse obesity, Type 2 diabetes and high blood pressure, while helping you boost your immune system to avoid both chronic diseases and illness from infectious agents alike:
Limit added sugars to a maximum of 25 grams per day. If you're insulin resistant or diabetic, reduce your total sugar intake to 15 grams per day until your insulin/leptin resistance has resolved (then it can be increased to 25 grams) and start intermittent fasting as soon as possible.
Limit net carbs (total carbohydrates minus fiber) and protein and replace them with higher amounts of high-quality healthy fats such as seeds, nuts, raw grass fed butter, olives, avocado, coconut oil, organic pastured eggs and animal fats, including animal-based omega-3s.
Avoid all processed foods, including processed meats. For a list of foods that are particularly beneficial for diabetics, please see “Nine Superfoods for Diabetics.”
Get regular exercise each week and increase physical movement throughout waking hours, with the goal of sitting down less than three hours a day.
Healthy middle-aged adults were able to improve their insulin sensitivity and blood sugar regulation after just two weeks of interval training (three sessions per week),30 while among people with Type 2 diabetes, just one interval training session was able to improve blood sugar regulation for the next 24 hours.31
Your body's ability to respond to insulin is also affected by just one day of excess sitting, which leads your pancreas to produce increased amounts of insulin. Research published in Diabetologia also found that those who sat for the longest periods of time were twice as likely to have diabetes or heart disease, compared to those who sat the least,32 so make sure to keep moving.
Get sufficient sleep — Most need right around eight hours of sleep per night. Research has shown sleep deprivation can have a significant bearing on your insulin sensitivity33 and immune function.
Optimize your vitamin D level, ideally through sensible sun exposure. If using oral vitamin D3 supplementation, be sure to increase your intake of magnesium and vitamin K2 as well, as these nutrients work in tandem, and monitor your vitamin D level.
Stress management should be a regular part of your immune-support and hypertension-reduction plan, as hypertension often has an emotional component to it, especially if you’re chronically stressed or anxious. Using the Emotional Freedom Techniques (EFT) is one excellent suggestion.
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