Health & Fitness

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.

Optimize your gut health by regularly eating fermented foods and/or taking a high-quality probiotic supplement.

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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The human body needs nutrients to survive. One piece of the puzzle is a water-soluble nutrient, vitamin B3. Deficiency may happen if you don't eat foods rich in vitamin B3; if you have dysfunctional absorption or a metabolic disorder; or if you’ve used chemotherapeutic agents for a long time.¹

The vitamin’s common name is niacin and it's a precursor to nicotinamide adenine dinucleotide (NAD), which is used to catalyze more than 400 enzymatic reactions in the body.² NAD is necessary for activities to repair DNA, and it’s essential for genome stability. The precursors to NAD are collectively called niacin. These are nicotinic acid, nicotinamide and nicotinamide riboside.

Tryptophan is an essential amino acid that can be converted into NAD in the liver. Once formed, NAD can be altered to other necessary forms — nicotinamide adenine dinucleotide phosphate (NADP), nicotinamide adenine dinucleotide (NADH) and nicotinamide adenine dinucleotide phosphate (NADPH).

Many animal-based foods are high in niacin, including pastured beef and poultry as well as wild-caught Alaskan salmon. These have higher amounts of bioavailable niacin than plant-based foods such as nuts and legumes.

According to the American Cancer Society, there are more than 16.9 million people in the U.S. who had cancer and were alive on January 1, 2019. It’s expected that more than 1.8 million more cases will be diagnosed in 2020.³

The traditional view of cancer is that it's a genetic disease. The American Cancer Society writes that just 42% of all cases are potentially avoidable. Yet, there is strong evidence that the genetic mutation found in cancer is a downstream effect of defective energy metabolism in the mitochondria, and not the primary source of cancer.⁴

Vitamin B3 Helps Slow Growth of Glioblastoma

Vitamin B3 also plays a significant role in the immune system. Researchers screened 1,040 compounds before testing niacin for the role it may play in helping the body fight glioblastoma.⁵ Glioblastoma is one of the more common brain tumors, and it’s the most lethal.⁶

Approximately 180,000 people in the U.S. are diagnosed with a glioblastoma each year, and once diagnosed most people live less than 15 months.⁷ Scientists think the reason a glioblastoma is so lethal may be attributed to brain tumor-initiating cells (BTICs) with stem cell-like properties.

These cells are adaptable and can turn the body’s macrophages, microglia and monocytes into promoting tumor growth instead of fighting it. In laboratory experiments, researchers found niacin could invigorate monocyte cells into once again fighting BTICs.

Building on this knowledge, the researchers conducted an animal study⁸ to test the effectiveness of niacin against cancer. When treated, the life of the mice was extended, and when used in combination with chemotherapy the results were even better. In the mice receiving the combination therapy, the life span increased from 40 days to 150 days.

One of the researchers, Wee Yong, Ph.D., from the University of Calgary’s Cumming School of Medicine, is encouraged by the results. While speaking to Inverse, he called the ability of niacin to help suppress brain cancer cells “remarkable,” and hopes this information will help spur other advances in the treatment of glioblastoma:⁹

“While it’s not a cure, it’s a promising step forward against this incurable disease. The brain tumor stem cells for glioblastoma have been very resistant to treatment, so instead of targeting those cells, we targeted the immune system to help the body to attack and destroy the stem cells.”

Research Shows Niacin Effective in Other Cancer Types

Researchers have been studying the effects of niacin and cancer for nearly three decades.¹⁰ In that time they’ve made some interesting discoveries, including the effect niacin has on the prevention,¹¹ development¹² and treatment of cancer.¹³

In one study¹⁴ researchers sought to evaluate the effect of niacin on serotonin-producing neuroendocrine tumors. The researchers engaged patients with these tumors, who were given niacin supplementation alongside healthy patients in a control group who did not receive the treatment.

Niacin levels were measured before and after the intervention. They found deficiency was prevalent and supplementation was effective in normalizing levels. However, the patients were not followed long-term, so no determination was made as to effects over time. The scientists suggested a prospective study should be done.

In another study,¹⁵ scientists found that the combination of loperamide (Imodium), a drug used to slow the effects of diarrhea, with niacin improved biochemical measurements in rats with liver cancer.

Cancer Is a Metabolic Disease

Each day more than 1,600 people in the U.S. die from cancer.¹⁶ Many of these deaths are unnecessary as they are preventable and treatable with the right therapies. Thomas Seyfried, Ph.D., is a pioneer in the application of nutritional ketosis for cancer, which we discuss in this short video.

His therapy stems from work done by Dr. Otto Warburg, who received the Nobel Prize for Physiology or Medicine in 1931 for his discovery of the metabolism of malignant cells. Following in Warburg's steps, Seyfried has spent years conducting research to advance the science. Mitochondria were not well understood during Warburg's time.

But advancements in technology have improved the appreciation of how they function. Seyfried sets the stage by pointing out that all major college texts identify a genetic base for cancer growths. This idea pervades the pharmaceutical and academic industries as well, driving research and quashing discussions of alternative views. He points out:¹⁷

“The argument now is that, yes, metabolic problems occur in cancer cells. No one denies that. But these are all due to the genetic mutations. Therefore we must maintain ourselves on the established track that all of this metabolic stuff could be resolved if we just understood more about the genetic underpinning of the disease.

Now that would be well and good if it were true. But the evidence is accumulating that the mutations we see that are the prime focus and the basis for the genetic theory are actually epiphenomenal. They're downstream effects of this disturbance in the metabolism that Warburg originally defined back in the 1920s and '30s."

A change in focus in the development of cancer would alter cancer treatments. If defective mitochondria are responsible for malignant growths, then treatment should include improving mitochondrial function. As Seyfried points out, inherited mutations may also impact mitochondrial health, and thus the development of cancer.

In “Top Tips to Optimize Your Mitochondrial Health” I explain why becoming an efficient fat burner is so important to supporting mitochondrial health. I also talk about the difference between healthy ketosis and diabetic ketoacidosis.

Niacin Necessary for Cognitive Health

The connection between niacin and brain and nervous system health is well established. Your nervous system requires adequate nutrition to maintain and optimize cognitive health and function. For instance, omega-3 fats — in particular, DHA — are vitally important to brain health.¹⁸ Specific vitamins are also important, and deficiencies are associated with cognitive decline.

If you become deficient, the most common symptoms involve your nervous system, skin and digestive system. The symptoms are referred to as a triad of the “three D’s” — sun sensitivity dermatitis, diarrhea and dementia.¹⁹ The fourth, when left untreated, is death.

Two of the neuropsychiatric clinical signs are delirium and dementia. Schizophrenia also shares some of the symptoms of pellagra, a condition caused by niacin deficiency.²⁰ Other B vitamins may also contribute to neuropsychiatric symptoms, including deficiencies in B1, B2, B6, B8 and/or B12.

The authors of one study²¹ found that the intake of B vitamins during young adulthood improved cognitive function during midlife, demonstrating the long-lasting effects of good nutrition.

Another group of researchers²² gathered data from 3,718 Chicago residents over the age of 65 who completed a nutrient questionnaire and underwent four cognitive tests at three-year intervals. The data revealed those with the highest niacin intake had the greatest protection against Alzheimer's disease and age-related cognitive decline.

How Niacin Flush Develops — Is it Dangerous?

Most people who use niacin supplements do so to help reduce their cholesterol levels. The supplement they use is nicotinic acid, which has a side effect called niacin flush. To reduce the potential of experiencing the side effect some choose to use niacinamide.²³

Symptoms of a niacin flush begin with tingling or burning sensation in the face, neck and chest. The skin turns red or flushed and the skin may feel warm to the touch.²⁴ Niacin triggers dilation of the blood vessels near the skin along with symptoms of the reaction. 

Over time, you may develop a tolerance, which reduces this effect. Although it is irritating and may be disturbing if you don’t expect it, a niacin flush is harmless. There are steps you can take as your body builds a tolerance, such as using smaller doses throughout the day, using a time-released version, taking it with meals and drinking plenty of fluid with the supplement.

Alternate Vitamin B3 Supplement Has Different Benefits

An alternate supplemental form of vitamin B3 is niacinamide, which is a form of niacin combined with an amino acid like tryptophan. Niacin and niacinamide are similarly effective in the body but their pharmacological properties are different.

Natural niacin and niacinamide can be obtained from your food; unlike supplemental niacin, these do not cause flushing. However, since it is a water-soluble vitamin, it’s not stored and instead is eliminated through the kidneys.

Niacinamide regulates cell regeneration, which makes it a popular ingredient in anti-aging products.²⁵ For more about niacinamide studies, dosage and side effects see “Niacinamide: Get to Know More About This Form of Vitamin B3.”

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Almost everyone’s dealt with flu at some point, and it’s wise to know what foods will help and what foods are actually hindrances.

To understand what to eat, consider both the symptoms and the source of your troubles in order to find a solution: Your body’s natural immune system needs to be supported while you work to combat the annoying and sometimes painful symptoms that flu can bring.

Whether you’re dealing with a mild case, fighting a fever and severe cough, or defending against muscle aches, cramps and diarrhea, there are certain foods you want to consume and definite ones to avoid.

Fending Off Nausea With Fluids

Finding the urge or even energy to eat can be a problem when you’re combating influenza, but there are some options that are easier than others.

According to Kacie Vavrek, a registered dietitian with The Ohio State University Wexner Medical Center, one of the primary points to consider is the state of your stomach: Don’t make things worse by consuming something that may not sit well. She writes:

“The flu often makes consuming food difficult, as flu symptoms can cause nausea or stomach symptoms. Nausea can decrease the desire to eat, and gastrointestinal symptoms like vomiting and diarrhea can be triggered if food is consumed too soon.

Eating nutrient-dense foods is useful no matter what kind of sickness you have. In fact, it’s especially important when you have a fever. But not all food is created equal. While comfort foods may be what you want when you’re not feeling your best, they’re not necessarily going to make you feel better.

In fact, I’d suggest avoiding your go-to comfort foods, as you may end up developing a distaste for them if you consume them when nauseated.”¹

Broth-based soups, including bone broth, can be a good option to sip on, as the soup replaces both fluids and sodium, both of which are crucial during times of illness. A study published over a decade ago found that chicken soup indeed has medicinal qualities, significantly mitigating infection caused by cold and flu viruses.²

Scientists at Nebraska Medical Center noted that chicken soup has a number of substances that likely account for its healing properties. The group tested a traditional chicken soup and found that it “significantly inhibited neutrophil migration and did so in a concentration-dependent manner.”³

They think this is due to the mild reductions in inflammation that you can realize from taking it in, but note that commercial soups may or may not offer such benefits.

Elderberry to Address Respiratory Issues

In February 2019, researchers from the Franklin Institute for Wellness in Franklin, Tennessee, published an article in the scholarly journal Complementary Therapies in Medicine. They conducted a meta-analysis of previously published randomized, controlled clinical trials related to the use of black elderberry in treating upper respiratory symptoms.

While taking into account factors such as overall health, the team reviewed studies that represented 180 participants who were given elderberry — also known as Sambucus nigra — as a supplement in their course of therapy.

They found that those taking the natural substance enjoyed significantly reduced upper respiratory symptoms and that broader use may introduce a safer alternative to prescription drugs.⁴

What to Eat if You Have a Sore Throat

If you have a sore throat, you'll want to avoid foods that may irritate or scratch your throat, such as nuts or acidic foods like lemon or orange juice. Soft, nutrient-dense foods, such as raw grass fed yogurt and kefir, mashed sweet potato or mashed cauliflower, will be easy to swallow. You can also sip on warm bone broth and green tea.

For calming, peppermint tea is a good option, as it has both pain-relieving and anesthetic effects. Add in a bit of raw Manuka honey, which has antibacterial activity and is known for helping with wound healing, if desired.

Honey has long been used as a natural remedy for sore throats, and modern research has confirmed that honey is such a potent anti-infection/anti-inflammatory product it can rival antibiotics.⁵ A common natural remedy for a sore throat is tea with honey and lemon. The main thing to remember when it comes to honey is that not all honey is created equal.

The antibacterial activity in some honey is 100 times more powerful than in others. Processed, refined honey is not recommended, as it does not impart the same health benefits as raw honey when consumed.

So make sure you're only using raw honey or Manuka honey to treat a sore throat. Another caveat is that you don't want to give honey to children under the age of 1 year,⁶ as botulism can occur due to the child's immature immune system if the honey is contaminated.

Breastfeeding Is Best, Even When Battling Flu

Nursing mothers may wonder whether they should switch their babies to formula when battling flu. According to the U.S. Centers for Disease Control and Prevention, since the condition cannot be transmitted via breast milk, and breast milk provides protection against influenza for the baby, it’s best to continue the practice:

“Breast milk provides protections against many respiratory diseases, including influenza (flu). A mother with suspected or confirmed flu should take all possible precautions to avoid spreading the virus to her infant while continuing to provide breast milk to her infant.”⁷

When babies, but not moms, have the flu, breastfeeding should also continue, with commonsense precautions included in either case, such as being careful not to sneeze or cough on the baby and washing hands frequently to avoid passing germs that cause disease.

Seven Types of Food for Flu Season

There are plenty of natural strategies to help protect yourself from all of the viruses and bacterial infections going around, and adding immune-boosting foods to your diet is one of them. Here are seven healthy types of food for flu season:

What Not to Eat When You’re Under the Weather

While you’re sick it’s important to avoid sugar, alcohol and greasy foods. On the one hand, your body needs all the energy it can get to go toward fighting off the illness. On the other, it’s important not to overeat or consume unhealthy foods.

If you feel yourself coming down with something like a cold or flu, this is not the time to be eating sugar, artificial sweeteners or processed foods. Sugar is particularly damaging to your immune system, which needs to be ramped up to combat an emerging infection.

So, if you are fighting the flu, you'll want to avoid sugar, and this includes sugar in the form of fruit juice and even grains (which break down as sugar in your body).

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Researchers moved one step closer to the ability to make heparin in cultured cells. Heparin is a potent anti-coagulant and the most prescribed drug in hospitals, yet cell-culture-based production of heparin is currently not possible. Heparin is now produced by extracting the drug from pig intestines, which is a concern for safety, sustainability, and security reasons.

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A prospective 'PARP inhibitor' drug that has struggled to show effectiveness in clinical trials against cancers can be structurally modified to greatly increase its power to kill tumor cells, researchers say.

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