by Dr. Joseph Mercola
While SARS-CoV-2 is a rampant virus that can cause
severe problems in vulnerable individuals, the real
pandemic - the underlying cause that makes people
susceptible to complications from the infection in the
first place - is poor metabolic health
Aside from old age, obesity has been identified as one
of the primary risk factors for being hospitalized with
COVID-19 - doubling the risk of hospitalization in
patients under the age of 60 in one study
hypothesis for why obesity is worsening COVID-19 has to
do with the fact that obesity causes chronic
inflammation. Having more pro-inflammatory cytokines in
circulation increases your risk of experiencing a
Insulin resistance is another top risk factor for
COVID-19 that worsens outcomes and increases your risk
There are five primary parameters of metabolic health:
waist circumference, insulin sensitivity, blood
pressure, and triglyceride and HDL levels. Having three
or more abnormal parameters is indicative of metabolic
is Key Risk
Factor for COVID-19...
While SARS-CoV-2 is a rampant virus that can cause severe problems
in vulnerable individuals, the real pandemic - meaning the
underlying cause that makes people susceptible to complications from
the infection in the first place - is metabolic inflexibility or
In this interview, Dr. Aseem Malhotra, a British cardiologist
and author of "The
21 Day Immunity Plan," delves into the specifics and
explains the role insulin resistance plays in the COVID-19 pandemic.
"The real pandemic is
poor metabolic health, or metabolic inflexibility," Malhotra
"I had become aware,
as early on as March, when we were getting data from China and
Italy, that there was a clear link between conditions related to
excess body fat, in simple terms defined as poor metabolic
health, [and] worse outcomes from COVID-19.
We're talking about conditions like Type 2 diabetes, high blood
pressure, heart disease and, of course, obesity. And that data
kept emerging. That link was so clear, and it wasn't just out of
As somebody who's been a practicing doctor for almost two
decades, it's very clear - we know people who have poor
metabolic health certainly tend to have worse outcomes from
really any infection, but COVID-19 has highlighted it more, and
made us think about it more.
We're talking about chest infections, hospital admissions with
pneumonia [and] Type 2 diabetics tend to do a lot worse.
I was looking at that
data and thought,
something missing out of this mainstream conversation.'
It was getting a lot
of immediate coverage across the world, in the U.K., in the
United States, but no one was talking about lifestyle."
Obesity Is a
Significant COVID-19 Risk Factor
Aside from old age, obesity has been identified as one of the
primary risk factors for being hospitalized with COVID-19 - doubling
the risk of hospitalization in patients under the age of 60 in one
study 1 - even if the individual has no other
obesity-related health problems.
A French study 2,3
also found obese patients treated for COVID-19 were more likely to
require mechanical ventilation.
One hypothesis for why obesity is worsening COVID-19 has to do with
the fact that obesity causes chronic inflammation. 4
Having more proinflammatory cytokines in circulation increases your
risk of experiencing a cytokine storm.
cytokine storm response is
typically the reason why people die from infections, be it the
seasonal flu, Ebola, urinary tract infection or COVID-19.
Obesity also makes you
more vulnerable to infectious diseases by lowering your immune
Resistance Augments Infection Risks
Obesity is often rooted in insulin resistance, brought on by a
flawed diet, and insulin resistance is another top risk factor for
COVID-19 that worsens outcomes and increases your risk of death.
An April 15, 2020,
article 11 in The Scientist reviews evidence 12,13
showing how higher blood glucose levels impact viral replication and
the development of cytokine storms.
While the research in question looked at influenza A-induced
cytokine storms, these findings may well be applicable in COVID-19
In a Science Advances
press release, co-author Shi Liu stated: 14
"We believe that
glucose metabolism contributes to various COVID-19 outcomes
since both influenza and COVID-19 can induce a cytokine storm,
and since COVID-19 patients with diabetes have shown higher
Factors Can Be Rapidly Ameliorated
The good news, as Malhotra stresses, is that the lifestyle factors
that make you more prone to severe COVID-19 infection and death can
be modified and ameliorated in as little as 21 days, simply by
changing your diet.
Like me, Malhotra feels
this has been sorely missing from pandemic response messaging.
"They should have
been saying, 'Listen, there's no better time for you to really
think about trying to improve your health and looking into what
you eat, [get] moderate exercise, sleep, all those things',"
"But it wasn't
To fill the information
gap, Malhotra began writing. Initially, he wrote a series of
articles for British newspapers.
He also got the
opportunity to speak about this on Sky News.
"I made it very
a chance at some point we're all going to get this virus,
and we want to make sure that we're in the best position to
be able to deal with it, so that we don't get sick from it
when it happens.'
I think I was
probably, maybe, the only doctor who had the opportunity to say
that in a mainstream media, probably in the world, at that time.
I think no one else
had said it..."
As more data became
available, Malhotra's writings turned into "The 21 Day Immunity
Malhotra also had the
opportunity to share information with the U.K. Secretary of State
for Health, Matt Hancock, and by the time the book was finished,
Prime Minister Boris Johnson came out saying something needs
to be done, on a policy level, about the obesity epidemic.
That said, we don't have to have government policies in place to
personally implement these lifestyle strategies.
The information is
available. It's well-documented, noncontroversial and relatively
simple to do. Surprisingly, Malhotra's message has been largely
well-received, and hasn't been censored to the extent that many
One of the bits of advice to start with is what you should cut out
ultraprocessed food and low quality carbs. That is really where we
need to start.
If you cut that out, then
you will also automatically reduce your refined carbs, sugar and
Unfortunately, we're still fighting against a tsunami of dietary
misinformation and false advertising on a daily basis, which makes
it difficult to really get this message out and make it stick.
"If every day the
government was putting out a message saying, 'Metabolic health
is the key,' then we would have a really big impact," Malhotra
Have Poor Metabolic Health
The central thesis of Malhotra's book is that we have a pandemic of
metabolic inflexibility or metabolic ill health.
There are five primary
parameters of metabolic ill health, which include having:
A large waist
Type 2 diabetes
or hypertension (high blood pressure)
If you have all of those
five parameters within the normal ranges, you are in good metabolic
health. Having three or more abnormal parameters is indicative of
can further be divided into two primary subsets, namely:
resistance, signs of which typically include high blood
pressure, high triglycerides, high cholesterol, obesity and
other variables connected with that.
In the U.S., NHANES data 15 published in 2016
reveal 87.8% of Americans are metabolically unhealthy, based
on five parameters. That data is over four years old now, so
the figure is likely greater than 90% of the population
According to a January 2019 update by the U.S. Centers for
Disease Control and Prevention, more than 122 million
American adults have diabetes or prediabetes 16 -
conditions which have been shown to increase your chances of
contracting and even dying from COVID-19.
Syndrome Triples COVID-19 Fatality Risk
"The data from
COVID-19 shows the highest risks of death and hospitalization
are in people with metabolic syndrome, not obesity.
doubles your risk of death, but with metabolic syndrome, it's
around a 3.5 times increased risk of death - more than threefold
- and about five times the risk of hospitalization if you get
So that is the major problem. And the reason why that's
important is it also affects many, many people. This is why BMI
[body mass index], to be honest, I think should be thrown out; I
mean, it's useless, it's outdated.
We should be looking at metabolic health, because up to 40% of
people with a so called normal BMI, who may be told they've got
a healthy weight, actually are metabolically unhealthy.
That's a huge
proportion of people, and there are disparities depending on
which ethnicity you're from.
But the basic problem with BMI, which is a calculation based
upon your weight in kilograms divided by your height in meters
squared, is it doesn't take into consideration your body fat
percentage, your muscle mass, your ethnicity …
It misses a huge group of people who are probably vulnerable and
could institute lifestyle changes to help themselves if they
were advised to do so. But a lot of them aren't being advised
because they're being told they've got a healthy weight.
If everybody knew their metabolic health markers and were then
given advice to do things about it, then, as I point out in the
book, within a few weeks you'd probably notice significant
changes. Of course, it's going to vary from person to person.
With regard to vitamin D, it is again something we've ignored
for a long time.
In the U.K., a
significant proportion of people are either deficient or
severely deficient in vitamin D, and it has such an important
role in immune function.
Most cell receptors
in your body have vitamin D receptors, and it is involved in
enhancing both innate and adaptive immunity."
The bottom line is you
need to have the five metabolic parameters listed above within the
normal ranges, and you need an optimal blood level of vitamin D,
which is now thought to be between 40 ng/mL and 60 ng/mL.
"There was a study in
Indonesia that showed that in people hospitalized with COVID-19
- those who had severe vitamin D deficiency versus those that
had normal ranges of vitamin D in their blood - there was a
tenfold difference in death rates, which is extraordinary. So,
[vitamin D] certainly has a very important role to play,"
"The ideal scenario is to get vitamin D from sunlight because it
actually stays in your bloodstream longer. But, certainly, at
least through the winter months, you should be taking a
And I think the good
thing about that is it's cheap …
I suspect getting good health actually is going to come from
just eating real food, and being out in nature, and doing more
exercise, and reducing our stress, and social connection; all of
those things, I think, are the key to longevity and good quality
How to Improve
Your Metabolic Health
So, just how do you improve those five metabolic parameters?
Malhotra addresses this in his book, of course.
In summary, to optimize
your metabolic health and reverse metabolic syndrome, you'll want
eliminate foods that promote insulin resistance -
Topping this list are processed foods high in
industrial seed oils, added
sugars and refined carbohydrates (i.e., bread, pasta and
probably one of the major dietary culprits," Malhotra
also, beyond its calorie issue, seems to have
independent effects and adverse effects on metabolic
So, sugar is one of the first things I always talk about
that people need to eliminate from their diet … Most
people you can break those addictions usually within
three to six weeks."
As explained in
interview with Dr. Chris
Knobbe, industrially processed seed oils such as canola,
corn and soy oil (most of which are also genetically
engineered) appear to be at the heart of most if not all
chronic diseases of the modern world.
Evidence suggests they may be an even greater health threat
than added sugar.
Malhotra has also
addressed this issue in his book, "The Pioppi Diet," 23
published in 2017.
Aside from more
direct harms, one of the ways in which these oils undermine
your health is by skewing your omega-3 to omega-6 ratio, as
they're excessively high in omega-6 linoleic acid.
When used in cooking, they also produce toxic, carcinogenic
In lieu of seed
oils, use healthy saturated fats such as coconut oil,
grassfed butter, organic ghee or
As noted by Malhotra:
"Combining all those
together - that synergy of the diet and all the other lifestyle
factors - has profound and rapid effects on health. So that's
where we need to change the narrative.
One of the bits of advice to start with is what you should cut
out ultraprocessed food and low quality carbs. At least go cold
turkey for a few weeks.
You may reintroduce
them or have them as occasional treats, but this should not be
making up the bulk of your calorie consumption.
That is really where we need to start. If you cut that out, then
you will also automatically reduce your refined carbs, sugar and
All of those things
are going to be significantly reduced from your diet."
Eating Schedule Boosts Metabolic Health
In his book, Malhotra also recommends implementing a
time-restricted eating schedule or
intermittent fasting where you limit your eating to a window of,
ideally, six to eight hours a day.
"My cousin, who lives
in California, struggled for most of his childhood and early
adulthood as being particularly overweight," Malhotra says.
"Now, he's probably
the slimmest and maybe the fittest member of the whole family
because he changed his diet.
"He is religious with his time-restricted eating. I mean, he
does it every day, and now he's literally got a flat stomach,
he's in optimal metabolic health and it's amazing. But he told
me it took time for him to really see the massive benefits of
It took about a year
to get rid of the last bit of fat around his belly."
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