A recent book published by Dr. Aseem Malhotra, already on the Sunday Times bestseller list, claims that within 21 days, people with obesity or who fall on the spectrum of metabolic disease, can reduce their susceptibility to SARS-COV2 infection severity by following this simple formula: “eat real food, move, relax, sleep”.
A rather bold claim to make, considering that the UK death toll from SARS-COV2 infection currently stands at around 41,500. A provocative, editor-selected headline that was subsequently replaced suggested that this was ‘the best vaccine”, and predictably produced a spirited, nuanced and reasoned reaction on Twitter.
The question one has to ask is: is there any evidence, for this claim? Is the “Malhotra method” the solution, or are his more strident critics justified in their passionate skepticism?
Multiple studies of different designs have addressed the impact of metabolic disease, insulin-resistance, diabetes, hypertension, obesity, sleep deprivation, stress and exercise on overall health, immunity and the ability to withstand a multisystem infection and it is to these that one must look in order to assess the potential veracity of Malhotra’s claims. We have recent studies that have established that all of these disease states increase the susceptibility of patients, to complications of SARS-COV2 infection.
Morbid obesity is associated with a 50 per cent increased risk of dying from SARS-COV2 infection and doubles the risk of hospitalization. Once hospitalized, obese patients are more likely suffer complications should intubation be required .
Is there an easy method whereby someone can begin to address their obesity given the current restricted access to non-SARS-COV2 NHS services in many areas? Indeed there is. We know that consumption of ultra-processed foods (UPF’s) cause excess calorie intake by not being satiating, and that they directly contribute to obesity and the development of insulin resistance and diabetes. We also know that 60 per cent of the total caloric intake in the UK consists of UPFs. By avoiding UPFs, one automatically reduces total caloric intake.
Metabolic disease exists along a spectrum. There are five criteria that establish abnormal values in regard to waist circumference, triglyceride and HDL levels, blood pressure and fasting blood glucose values. Anyone possessing one of the criteria is on that spectrum. A patient with three or more of the five criteria is diagnosed with “metabolic syndrome”.
Not everyone who is obese will have metabolic syndrome and not everyone with metabolic syndrome is obese. 88 per cent of Americans and possibly the same proportion of people in the UK, are metabolically unhealthy regardless of their weight.
Insulin resistance is a fundamental part of the metabolic disease spectrum and has a deleterious effect on the immune system, partly explaining why those with it are at higher risk of severe SARS-COV2 infection.
Angiotensin Converting Enzyme 2 (ACE2) receptors serve as an attachment point for the virus as it enters human cells; receptors for this enzyme are found in the lungs, among other tissues. Elevated blood levels of insulin and glucose, lead to higher levels of this enzyme and its receptors. They also contribute to the “cytokine storm” which results from an abnormal immune response which causes multi-organ damage in severe SARS-COV2 infection as well as impaired activity of several important cells of the innate immune system. This propensity for infection has been demonstrated with another corona virus, H1N1.
The observable impact of metabolic syndrome on SARS-COV2 infection severity is profound. A three-fold greater risk of death is noted, as is a five-fold higher risk of needing intensive care or a ventilator; similar risks are seen for diabetes and hypertension.
Higher blood sugar levels alone, in the non-diabetic range, are also a risk factor for death within 28 days of hospital admission.
So can metabolic disease (insulin resistance) be improved, treated or cured via non-medication manipulation?
A program of stress reduction, has been associated with improved insulin resistance given that stress itself can cause insulin resistance. Sleep deprivation can rapidly cause insulin resistance. But interestingly, high-intensity exercise can mitigate this effect.
Exercise of any kind, itself, has been shown in multiple studies to improve insulin resistance, independent of any weight loss.
A meta-analysis of randomized controlled trials, supports a low-carbohydrate diet for patients with type 2 diabetes and metabolic disease with improvements in insulin level, blood sugar and inflammatory markers demonstrable.
A smaller observational study suggests that rapid improvement in markers of insulin resistance and cardiovascular risk factors may be seen in as little as two weeks with carbohydrate restriction.
Lest anyone think I am pushing the low-carb “agenda”, another study found that a low-fat, high-fibre diet in conjunction with exercise was associated with significant biochemical improvement; 50 per cent of patients experienced reversal of metabolic syndrome within 21 days.
For those people with obesity and metabolic syndrome, modest weight loss was associated with significant improvements in markers of metabolic syndrome or even resolution within a 4 week period.
Improvements in biochemical markers for metabolic syndrome can be seen within 9 days simply by substituting processed sugars for starch, without altering the caloric content of the rest of the diet.
Clearly there is some merit to what Malhotra is recommending. Given that metabolic disease, diabetes and cardiovascular disease are among the most significant risk factors for severe SARS-COV2 infection, ameliorating their impact on the health of vulnerable people should be a non sequitur.
One wonders why those with the power to affect change have not been taking advantage of the opportunity lockdown protocols have afforded to improve the nation’s health via a sustained focus on metabolic health improvement strategies. Given that metabolic disease and obesity disproportionately affect the poorer members of society, there should be all the more impetus to intervene.