we have learned so much since seeing our first covid-19 patient in the intensive care unit (icu). we have learned how to protect ourselves. we have learned how to best treat and manage our covid-19 patients, and we have a better appreciation of the outcomes of this viral illness. one thing that has been clear from the start of this pandemic is most of the covid-19 patients who land in icu have poor metabolic health. simply put, this means that it is typical for our covid-19 patients in the icu to have pre-existing conditions such as diabetes, obesity and high blood pressure.i have personally observed this among the patients i treat in the icus in ottawa, and it is also well documented in scientific literature. a study
published in the lancet reported that, among the early cases of patients hospitalized with covid-19 in wuhan, 50 per cent of patients had underlying comorbidities, which included diabetes (20 per cent), hypertension (15 per cent), and cardiovascular disease (15 per cent). similarly, of the 122,653 covid-19 cases reported to the center for disease control in the united states between feb. 12 and march 28, 2020, one third of patients had at least one comorbidity, which
was most frequently diabetes. additionally, 78 per cent of icu admissions and 94 per cent of deaths occurred in people with at least one comorbidity.it is obvious that poor metabolic health can lead to poor outcomes in patients with covid-19 infections. a june 2020 lancet
editorial broke it down nicely: “we have not just been fighting a communicable disease alone but also a growing backdrop of non-communicable disease (such as diabetes and obesity) that needlessly raise the death toll.” based on the emerging research on covid-19 and on my own clinical practice, it is evident that metabolic health plays a significant role in patient outcomes and must be prioritized in the fight against covid-19.
covid-19 as a catalyst to better health
why am i bringing this up? my intention is not to fat-shame; instead, it is because we can and we should be doing something about metabolic health. we can use the global covid-19 pandemic as a catalyst to become healthier people. type 2 diabetes is reversible. whether it is through approaches such as low-carbohydrate, ketogenic or intermittent fasting, people can reverse their type 2 diabetes in mere weeks while at home. yes, weeks! a
randomized control trial in 2017 showed that following a short course of intensive weight loss, some patients achieved a prolonged, drug-free diabetes remission. generally, restricting carbohydrates and ensuring adequate protein in the diet is effective in improving metabolic health fairly rapidly. an a-z weight loss study in the journal of the american medical association
indicates that a low-carbohydrate, high-protein, high-fat diet may be an appropriate approach for weight loss. there are many ways to achieve weight loss success, and it boils down to eating less, eating well and moving your body.in a year with lots of negatives, imagine turning things around and creating positive lifestyle changes. rather than accepting a sedentary lifestyle due to the pandemic, we could actively encourage healthier choices like taking walks after meals, limiting processed foods and choosing to eat more whole foods. moving forward, dietary education can serve as an important strategy to improve metabolic health.enhanced collaboration between the medical and public health fields and collective campaigning in our communities is essential to change the narrative and improve the health of canadians. educating the public about sustainable diet and lifestyle changes and focusing on the promotion of upstream, preventative strategies could mean that thousands of people take better control of their health and avoid serious illness from covid-19.the global pandemic must be the motivation people need to make a change. now is the time — no more excuses. it is not common knowledge how quickly we can reverse disease with lifestyle modifications, even among most endocrinologists, internists and family physicians. diet counselling and nutrition are traditionally left out of the medical school curriculum; therefore, the power of a low-carbohydrate, ketogenic or fasting diet to reverse disease is not promoted to improve patient health. my sample size is not large, but i have yet to take care of a covid-19 patient without metabolic risk factors. along with public health measures like social distancing and wearing a mask, a new focus on improving metabolic health could be extremely powerful in countering covid-19.enhancing metabolic health is a powerful, yet underappreciated, means to combat covid-19. and we know it can also reduce cancer, stroke and cardiovascular mortality risk. improving metabolic health can have a positive impact both in the short-term by enhancing the health of canadians in the face of covid-19, as well as in the long-term in the context of healthcare system capacity, resource use and hospital cost-effectiveness. this is especially important given canada’s aging population and the overcrowding and overcapacity typically seen in our hospitals. now more than ever, it is time to focus our efforts on empowering canadians to take control of their metabolic health to help combat covid-19.
dr. kwadwo kyeremanteng is an intensive care and palliative care physician in ottawa, canada and the host of the podcast solving healthcare.don’t miss the latest on covid-19, reopening and life. subscribe to healthing’s daily newsletter covid life.
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