Too Much and Too Little is Killing Us – reducing comorbidities

I just got “the call” that my mother who lives on the other side of the country, has tested positive for Covid-19. She has all of the major comorbidities, so prognosis is not good. Following the news, most of us know that age, obesity, hypertension and diabetes are known to significantly increase the risk of requiring hospitalization and death from Covid-19 (you can read more about that here, here and here), yet all but one of these comorbidities can be put into remission.  We can’t change our age, but we CAN reduce our weight, lower our blood pressure and normalize our blood sugar. To improve our quality of life outside of the pandemic, and to have the best chance of fighting it off if (or more likely when) we get it, we need to put our energy into achieving a normal body weight (and waist circumference), blood pressure and blood sugar now.

I am from a family of people that always ‘battled with their weight’.

My dad was tall and very fit when he was younger, a boxer and a ski-jumper but as he aged he accumulated excess weight around his middle. He then developed type 2 diabetes, high blood pressure and heart issues and eventually was diagnosed with Alzheimer’s disease, which is sometimes referred to as ‘type 3 diabetes’ by some clinicians. I wrote this article about that when he was first diagnosed.

My dad died just a few weeks shy of his 91st birthday, which is a ‘ripe old age’ of course, but for the last 40 years of his life, he was not in good health. He took several medications due to multiple metabolic conditions related to his diet and lifestyle. Except for his age, many of these conditions could have been put into remission — or at very least, been much better controlled with a change in diet and lifestyle.

My mom will be turning 85 this fall, and has been overweight since I was little. She too has type 2 diabetes and takes multiple medications for various conditions, many related to diet and lifestyle; conditions which could have been greatly improved, if not put into remission with a change in diet and lifestyle. It wasn’t for lack of trying “diets”. When I was young, she weighed her food, counted points and went to “groups” and at times she lost weight, only to put it all back, and then some. Eventually, she stopped trying. I can’t say that I blame her, given what I now know about the drivers to hunger.

Shared comorbidities

When I became overweight and then obese, and developed type 2 diabetes and high blood pressure, I justified that I was at high risk since both of my parents had the same.  I realize now that the “high risk” was our shared diet and lifestyle, more than genetics. Our shared comorbidities were adopted.

I grew up loving to eat good food and unfortunately considered food as both a reward, and a comfort. When someone was happy, we celebrated with good food. When someone was sad, we consoled with “comfort food”.  Food was “medicine”, but not in a good way. It didn’t heal, but contributed to the underlying hyperinsulinemia that drove the disease process. (I’ve written several articles about this topic, but if you only want to read one, I’d recommend this one.)

Those who have followed me for some time know that 3 years ago I began what I call my “journey”.  It took almost two years to do, but I lost ~60 pounds and a foot off my waist and I put my dangerously high blood pressure and uncontrolled type 2 diabetes into remission, as a result.  I recently posted a summary here, to mark my three year health recovery anniversary; two years of active weight loss and a year of maintenance.

Left: April 2017, Middle: April 2019, Right: April 2020

So why am I writing this post?

Like many people, I am upset by this whole “Covid thing” — not just because of my mom being diagnosed. I’ve been following the news, and realize that the hope for a vaccine any time soon is dim, and effective treatments are still lacking. An article published in the journal The Lancet the other day reported that while ~90% of those who have been hospitalized with severe Covid-19 develop IgG antibodies in the first 2 weeks, in non-hospitalized individuals with milder disease or with no symptoms, under 10% develop specific IgG antibodies to the disease.  That means that except for the sickest people who actually survive being hospitalized for several weeks with Covid-19, more than 90% of people who get Covid-19 and recover outside of hospital don’t develop antibodies to this virus [1]. Since the whole purpose to develop a vaccine is to challenge the body to develop antibodies to the virus — the very fact that most of the time people who don’t get that sick don’t develop antibodies, means that the likelihood of most people developing antibodies to a vaccine may be minimal.  As well, in light of this data herd immunity is also a dim prospect because most people that get this disease don’t produce antibodies, which means they aren’t immune and can probably get this virus again.

With little immediate hope of an effective vaccine or of herd immunity, what CAN we do to lower our risk?

I think that we first need to realize that many experts believe it is simply a matter of time until we are all exposed to the SARS-CoV2 virus and develop Covid-19, so we must look at lowering our risk of having a poor outcome. We can’t change our age, which is the biggest risk factor but we CAN do something to change the high risk comorbidities such as obesity, high blood pressure and diabetes.

Too Much and Too Little is Killing Us

For many of us, having both too much and too little is killing us.

We have diets with way too much refined carbohydrate, usually combined with large amounts of refined fat, and our usual diet is full of these in the form of pizza, pastries, take out foods and snack foods.  We now know from a study that was published almost 2 years ago[2] that this combination of both refined carbs and fat results in huge amounts of the neurotransmitter dopamine being released from the reward centre of our brain — way more than when we eat foods with only carbohydrate, or only fat separately. This huge amount of released dopamine results in us wanting to eat these foods, and craving these foods, and being willing to pay more for these foods than foods with only carbs or only fat [2]. Dopamine makes us feel good, and is the same neurotransmitter that is released during sex and that is involved in the addictive “runner’s high” familiar to athletes. This is one powerful neurotransmitter! It is this dopamine that is driving why so many people on “lock-down” have turned to baking bread and pastries for comfort, and buying snack foods with this same combination once they finally get through a long line to get into a grocery store! 

Too much of these refined “foods” is contributing to 1/3 of Americans and 1/4 of Canadians being obese, and another 1/3 in both countries being overweight. These foods are driving the hyperinsulinemia that underlies many metabolic conditions, including type 2 diabetes and hypertension.  These diseases were killing a great many of us before Covid-19, but knowing that these comorbidities increase our risk of hospitalization and death when we get the virus, why don’t we consider limiting these? I think it is because eating these foods make us feel good and so we self-medicate our stressful lives with something that is socially acceptable. High carbohydrate and fat foods are much more socially acceptable but what will it take for us to see that this for what it is and to consider that we need to change how we eat. If we aren’t willing to admit that our obesity, high blood sugar and high blood pressure are a problem, then maybe we are simply in denial. I certainly was, and wrote about this in “A Dietitian’s Journey”, the account of my own health recovery.

No, I am NOT saying that “all carbs are evil” and I’ve written about this previously, but we need to differentiate between what most of us eat as “carbs” and whole, real food that have carbs in them. I believe we need to eat significantly less of the refined foods that are contributing to our collective weight problem and metabolic health issues, and eat more of the real, whole foods that have gone by the wayside in our diet. I’ve written about the science behind this type of dietary change in many previous articles, and that eating this way is both safe and effective. What I can’t do is motivate people to want to change.

It is my hope that by presenting the evidence, as I have in several recent articles posted on this website that comorbidities such as obesity, hypertension and diabetes are significant risk factors to requiring hospitalization or of dying of Covid-19, that it may motivate some people to consider making some changes. If not now, when — especially given that the hope of a vaccine and/or herd immunity is likely a long way off.

I wish each of you good health and a long life.

If I can help, please let me know.

Joy

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Reference

  1. Altmann DM, Douek D, Boyton RJ, What policy makers need to know about COVID-19 protective immunity, The Lancet, April 27, 2020, DOI:https://doi.org/10.1016/S0140-6736(20)30985-5
  2. Di Feliceantonio et al., 2018, Supra-Additive Effects of Combining
    Fat and Carbohydrate on Food Reward, Cell Metabolism 28, 1–12