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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 insulin resistance.
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 says. “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 the blue.
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, ‘There's 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.”
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 study1 — even if the individual has no other obesity-related health problems. A French study2,3 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.
A 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 function.5,6,7,8,9,10
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, article11 in The Scientist reviews evidence12,13 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 as well. 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 mortality.”
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,” Malhotra says. “But it wasn't happening.”
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 clear. I said, ‘Listen, there's 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 Plan.” 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 others have.
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 says.
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:
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 metabolic syndrome. Metabolic inflexibility can further be divided into two primary subsets, namely:
1. Insulin 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 data15 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 today.
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 prediabetes16 — conditions which have been shown to increase your chances of contracting and even dying from COVID-1917,18,19,20,21,22
2. Vitamin D deficiency
Malhotra notes:
“The data from COVID-19 shows the highest risks of death and hospitalization are in people with metabolic syndrome, not obesity. Obesity probably 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 COVID-19.
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,” Malhotra says.
“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 supplement. 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 of life.”
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 to:
• Limit or 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 white rice).
“Sugar is probably one of the major dietary culprits,” Malhotra says. “It certainly also, beyond its calorie issue, seems to have independent effects and adverse effects on metabolic health …
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 my 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 aldehydes. In lieu of seed oils, use healthy saturated fats such as coconut oil, grassfed butter, organic ghee or lard.
• Be more physically active — This too can ameliorate and reduce metabolic disease risk markers. Just be mindful not to go overboard, as excessive exercise will actually lower your immune function and put you at increased risk of respiratory infections.
• Optimize your sleep.
• Reduce your stress.
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 omega-6 oils. All of those things are going to be significantly reduced from your diet.”
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. It took about a year to get rid of the last bit of fat around his belly.”
To learn more, be sure to pick up a copy of Malhotra’s book, “The 21 Day Immunity Plan.” It’s an easy read that emphasizes and summarizes the core lifestyle basics you need to understand and apply to improve your metabolic health, which in turn will reduce your risk of complications should you come down with symptomatic COVID-19 illness. Social Media info for Dr. Malhotra can be found on his site at doctoraseem.com.
Dr. Mercola Interviews the Experts
This article is part of a weekly series in which Dr. Mercola interviews various experts on a variety of health issues. To see more expert interviews, click here.
This week, we celebrate our 10th anniversary of Vaccine Awareness Week. In this video, Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center (NVIC), summarizes the high and low points we’ve experienced over the past year, and shares the details about NVIC’s international public conference on vaccination.1
Due to fluctuating social distancing rules and COVID-19-related travel bans, for the first time, this three-day conference will be held entirely online, October 16 through 18, 2020. The theme of this conference will be “Protecting Health and Autonomy in the 21st Century.” I invite you to attend by registering now. Since the conference is virtual, you now have the rare opportunity to attend no matter where you live.
“I was so excited to see how many credentialed scientists and physicians, state senators, authors, human rights activists — how many people agreed to participate,” Fisher says.
“We have more than 40 high-caliber speakers who are going to be presenting at this three-day conference. It also features two films ... We have kept the ticket price really low to try to allow families around the world to be able to see this conference … [It’s just] $80 for three days and three nights of knowledge.”
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The conference is divided into four primary themes:
Following are the scheduled speakers and the topics of their presentations:
Chris Exley, Ph.D. — Aluminum Toxicity and Human Health |
Jacob Puliyel, M.D. — Redefining Vaccine Reactions to Erase Evidence of Harm |
Dennis Rancourt, Ph.D. — From Masking to Mortality Rates: COVID-19 and What the Science Tells Us |
Vicky Pebsworth, Ph.D., R.N. — Novel Technologies Driving the Creation of COVID-19 Vaccines |
Alan Kassel — Consensus Science Is Not Science Because Science Is Never Settled |
Malcolm Kendrick, M.D.— Manipulating Science to Endorse Policy and Market Products |
Meryl Nass, M.D. — From Anthrax to COVID-19: What You Need to Know About One Company Making a Coronavirus Vaccine |
Sin Hang Lee, Ph.D. — Risks and Failures of HPV Vaccines for Cervical Cancer Prevention |
Theresa Deisher, Ph.D. — Ethical Vaccines and The Use of Human Fetal Cells to Make Vaccines |
Rodney Deitert, Ph.D. — Why the Microbiome Matters |
Richard Deth, Ph.D. — Inflammation, Epigenetics, Autism and Lessons for COVID-19 Vaccines |
Dawn Richardson — U.S. Vaccine Mandates in State Legislatures Since 2010 |
Ted Kuntz and Rocco Galati, J.D. — The Lobby to Remove Vaccine Choices in Canada |
Kris Gaublomme, M.D. — The European Experience with Mandatory Vaccination |
Michael Farris, J.D. — Why Homeschooling Is Under Attack and What You Can Do About It |
Rabbi Michoel Green — Ethical Questions on Mandatory Vaccination: Respecting Life and Guarding Your Soul |
Bishop Joseph Strickland — Rejecting the Culture of Death to Embrace the Sanctity of Life |
Eric Metaxas — The Role of Freedom of Conscience for Martin Luther and the Protestant Religion |
Stephanie Christner, D.O. — The Shrinking Medical Vaccine Exemption Handcuffing Doctors and Increasing Vaccine Risks |
Alvin Moss, M.D. — Why and How Vaccine Mandates Violate the Ethical and Legal Right to Informed Consent |
Larry Palevsky, M.D. — The Physician's Duty to First Do No Harm |
Bob Sears, M.D. — When Public Policy Invalidates Professional Judgment: A Pediatrician's Experience |
David Brownstein, M.D. — Since When Did It Become a Crime to Support the Immune System? |
Eric Plasker, D.C. — Raising Healthy Families the 100-year Lifestyle Way |
State Sen. Scott Jensen, M.D. — Censoring Freedom of Speech: If It Can Happen to Me, It Can Happen to Anyone |
Ronnie Cummins — Grassroots Rising |
Joseph Mercola, DO — How To Take Back Control of Your Health |
Barbara Loe Fisher — Defending Life and Liberty in the Vaccine Culture War |
Robert F. Kennedy Jr., J.D. — Pharmaceutical Companies Must Be Held Legally Accountable for Vaccine Injuries and Deaths |
Odette Suter, D.V.M. — What Veterinary Science Tells Us About Pet Vaccines |
Steven Rubin, Ph.D. — What Has Happened to the Vaccine Adverse Event Reporting System? |
Twila Brase, RN, PHN — Electronic Health Care Records Tracking You from Birth to Death |
Marco Cáceres — Tyranny of the Experts: Who's Fact Checking the Fact Checkers? |
Sherri Tenpenny, D.O. — Mandatory Vaccination: Adults are Next |
Kevin Jenkins — Knowledge is Power |
State Sen. Heidi Sampson — Under the Influence: The Vaccine Mandate Lobby Influencing State Legislatures |
Andrew Wakefield — Past is Prologue: What the History of the 1986 Act Reveals |
Sheila Ealey — When Mothers are Silenced, Children Suffer |
Andrew Kaufman, M.D. — Psychological Warfare in the COVID-19 Era |
Vera Sharav — Doctors Guilty of Medical Atrocities: From Auschwitz to Tuskegee, Willowbrook and Beyond |
Del Bigtree — Walking the Highwire: You Never Walk Alone |
Obviously, the biggest event over the past 12 months has been the COVID-19 pandemic, and the ultra-rapid development of a pandemic coronavirus vaccine which may or may not become mandatory around the world. Fisher has put together a special report on COVID-19, which she continues to update.
“Certainly, the polling is confirming — not just in the United States, but around the world — that people are losing faith in the vaccine system; they are losing faith in vaccine safety and effectiveness. A lot of it has to do with what has happened this year,” she says.
"This has been a public relations disaster, in my opinion, for the public health profession. They are the ones that have advised politicians around the world, lawmakers, to institute these draconian restrictions, the social distancing, isolation, deprivation — restrictions on people for an infection that at this point has a mortality [rate] of less than 1%.
It doesn't even compare to some of the infectious diseases that have plagued humans in the past, most notably Ebola, which has a 50% mortality rate, smallpox 30%, diphtheria 10% to 20%.
It's just so outsized [and[ out of balance what they've done, and caused a lot of protests all around the world, and a lack of trust in the system. So, it's their own fault for making people more skeptical.”
Through it all, the NVIC has continued to monitor legislation in the U.S. Many state legislatures have been working remotely, not allowing people to come into the state capital buildings. As a result, many more Americans are now using the free online NVIC advocacy portal to email and to call their legislators — which is what it’s there for.
“We also have been encouraging people to meet one on one with their legislators, which is the most effective way that you can talk with people and convince them that they need to take a look at these vaccine laws that don't allow exemptions,” Fisher notes.
"What I learned when I worked on Capitol Hill was the people who really run the place are the legislative aides. They're the ones [who] really create the legislation. They're the ones [who] recommend to the member what they should do. I think a lot of people don't realize the power that people have who work for congressmen and senators at the federal and state level.
So, if you're not able to meet with your actual member, don't be upset. You need to meet with the people who are advising him or her and make sure that you are clear about where you stand, and, of course, a legislator wants to get reelected. So, you have to make your voice heard.”
So far, this year, and we’re only in September, NVIC has issued positions and tracked 232 vaccine related bills in 39 states. That's the highest number of vaccine-related bills ever to have been introduced in state legislatures in one year. There were 13 bills in 10 States that sought to eliminate vaccine exemptions. None passed.
Of 10 bills filed across eight states to restrict vaccine exemptions, only one passed (Colorado) requiring a vaccine provider signature or completion of an online education module for religious or conscientious exemptions.
In total, there were 99 bills that NVIC supported — bills expanding vaccine exemptions, the right to make vaccine choices, and offering protection against vaccine tracking systems and a few of these good bills did pass. Of the 123 vaccine bills NVIC opposed, only eight bad vaccine bills passed.
“That's a remarkable statistic,” Fisher says. “It is absolutely a tribute to the people who are using the NVIC advocacy portal. They are taking the guidelines and the analyses that we publish, they're looking at the information, they're getting their facts straight, and they're contacting their legislators. This is true grassroots advocacy …
In 2015, there were only 19 bills that NVIC supported. So, in five years, we've gone from 19 bills that were good in 2015 to 99 good bills in 2020. That also shows you the power of really encouraging people to stand up for their rights and to communicate with their legislators …
There was a very bad vaccine bill [that] passed in Virginia, one of the worst that has ever been passed. That is a bill that would codify into law the Advisory Committee on Immunization Practices’ (ACIP) recommendations without public hearings, without input really to the legislators, without a vote by the legislator.
Whenever the ACIP makes a recommendation that children should use a certain vaccine, in Virginia it will automatically be put onto the state mandated list [of vaccines] for children to attend school.
The Board of Health will do a review, but the Board of Health is politically appointed. So, basically, what Virginia did is they cut the people out of the process. No longer will there be a vote. So, all the advocacy work that we're encouraging, that's how they're going to try to cut it off.
I predict they're going to try to go state by state with this legislation they passed in Virginia and make every state that way, cutting the people out of the legislative process, which is a direct threat to democracy.”
Fisher is convinced any COVID-19 vaccine, which makes it through licensing approval by the FDA and is eventually recommended by the CDC’s Advisory Committee on Immunization Practices, will eventually be mandated by state governments for all children. Clearly, the COVID-19 pandemic is unquestionably one of the greatest threats to freedom and liberty we’ve ever faced in modern history.
“The way that they will do that is [through] social sanctions. They will try to get businesses to make it a requirement that you have to have a COVID-19 vaccine in order to work in an office. They will make it mandatory for anyone entering a public space. That's what their goal is. Whether they achieve that or not is up to us. It's up to the people ...
What they have done is unprecedented. This has never occurred in the history of the world and what is so remarkable is that, when you take a step back and look at it, you see that it is highly orchestrated.
How in the world did all the governments, including the U.S. government, decide to shut down their societies — causing widespread, catastrophic, global economic ruin, unemployment at unprecedented levels, small businesses being destroyed?
They [small businesses] will never come back, or it's going to take a long time to come back. Mental health issues and suicides are up, anxiety and depression rates are up, child abuse and spousal abuse rates are up. Hotlines are not able to manage all of the callers because people are in a state of shock and they're suffering — for what?
Yes, you can die and you can be injured by this COVID-19 infection, just like any other infectious disease. But the fear and anxiety that has been created, the pathological fear of being near anybody, ‘Don't touch anybody. Don't be near anybody.’ You would think it was Ebola and people were literally bleeding out in the streets.
This is like influenza or other respiratory infections. But look at Sweden’s per million death rate. They did not lock down. Their chief epidemiologist said, ‘We need to allow controlled herd immunity to take effect. This is an infection. It's going to go through the population. You cannot stop it. You have to manage it, but let's get herd immunity.’2
They [in Sweden] have a lower per million death rate than the United States where we tried to lock everything down. So, the science is not all in and, yet, they're rushing to bring these vaccines out using messenger RNA and DNA technology that has never been licensed for humans. There are all these calls to mandate, to make sure that every man, woman, child takes this vaccine.
This is a coronavirus, it's in the family of coronaviruses that cause the common cold. There are studies showing that it looks as if you can have a mild case of COVID-19 and still get T-cell memory helper cells that are resisting the COVID-19 infection … They also know that you can have a mild case, and it looks as if you can get immunity without even having high antibody levels.3 To me, this is a game changer.
They are having clinical trials and the standard, the measurement they're using to measure proof of immunity, is antibody titers, when the truth is — for this virus — you can have T-cell immunity and no antibodies, but still be immune!4
The other issue is, we could have herd immunity already in the U.S. A lot of asymptomatic people won't be counted as being COVID-19, so you could have herd immunity in this country already, or getting close to it, but they simply aren't measuring for it.”
There’s no shortage of historical precedents when it comes to devastating pandemic vaccine campaigns. Aside from the 2009 pandemic swine flu vaccine campaign, which led to thousands of children and teens developing narcolepsy5 in Europe6 caused by the Pandemrix vaccine, there’s also the 1976 swine flu fiasco, detailed in this 1979 “60 Minutes” episode.
Fearing a repeat of the 1918 Spanish flu pandemic, all Americans were told to get vaccinated. According to “60 Minutes,” 46 million Americans were vaccinated against the swine flu at that time. Over the next few years, thousands of Americans filed vaccine damage claims with the federal government,7 severely marring the public’s perception of flu shots.8
According to a 1981 report9 by the U.S. General Accounting Office, as of October 2, 1980, 3,965 claims and 1,384 lawsuits had been filed. Of the 3,965 claims filed, 316 claims were settled for $12.3 million. Considering the COVID-19 vaccine is using novel RNA and DNA technology, it seems foolish not to assume there will be significant adverse consequences.
“We don't know what's going to happen when you give a vaccine to someone who has already recovered from COVID-19. We don't know how the immune system is going to react to rechallenge. We don't know what's going to happen to people who have underlying medical conditions, people who have severe allergies, autoimmune disease. Everybody's different,” Fisher says.
"This one size fits all approach has always been dangerous. And the ignoring of vaccine reactions, writing them off as coincidences, this has become a pattern in vaccine clinical trials. Whenever a serious event happens, or a death event happens, the investigators write it off as not associated.
What's that about? It's not being truthful. They don't know if it's related or not. But who makes that decision and why are they making those decisions? That skews the way the vaccine safety profile is being presented to the public.
You really have to look at the data. You have to look at the studies and understand the methodology they used, before coming to a conclusion about whether they've proved to safety and effectiveness. That's what we try to do at NVIC, and put it out in lay terms so that people understand it.”
As in previous years, during Vaccine Awareness Week, we will match donations made to the NVIC dollar for dollar, so it’s a great time to leverage your charity. You can make a tax-deductible donation here.
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This year, the best bang for your buck is to purchase a ticket to the NVIC’s international public conference on vaccination.10 Any profits generated from the event go to support NVIC’s work through public education to prevent vaccine injuries and deaths and to protect vaccine choices and civil liberties, including freedom of thought, speech and conscience.
For just $80, you get access to 40 speakers — that’s just $2 per lecture — plus viewings of two full-length films!
You also can offer your personal support for this historic event by becoming an NVIC conference sponsor with a one-time donation of $250 or more, which gives you two tickets plus your family or organization name recognition. It also grants you permanent access to the conference speaker presentations online. The NVIC would not have been able to keep the general admission ticket price affordable had it not been for the generous support of conference sponsors.
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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 insulin resistance.
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 says. “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 the blue.
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, ‘There's 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.”
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 study1 — even if the individual has no other obesity-related health problems. A French study2,3 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.
A 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 function.5,6,7,8,9,10
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, article11 in The Scientist reviews evidence12,13 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 as well. 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 mortality.”
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,” Malhotra says. “But it wasn't happening.”
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 clear. I said, ‘Listen, there's 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 Plan.” 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 others have.
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 says.
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:
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 metabolic syndrome. Metabolic inflexibility can further be divided into two primary subsets, namely:
1. Insulin 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 data15 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 today.
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 prediabetes16 — conditions which have been shown to increase your chances of contracting and even dying from COVID-1917,18,19,20,21,22
2. Vitamin D deficiency
Malhotra notes:
“The data from COVID-19 shows the highest risks of death and hospitalization are in people with metabolic syndrome, not obesity. Obesity probably 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 COVID-19.
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,” Malhotra says.
“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 supplement. 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 of life.”
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 to:
• Limit or 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 white rice).
“Sugar is probably one of the major dietary culprits,” Malhotra says. “It certainly also, beyond its calorie issue, seems to have independent effects and adverse effects on metabolic health …
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 my 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 aldehydes. In lieu of seed oils, use healthy saturated fats such as coconut oil, grassfed butter, organic ghee or lard.
• Be more physically active — This too can ameliorate and reduce metabolic disease risk markers. Just be mindful not to go overboard, as excessive exercise will actually lower your immune function and put you at increased risk of respiratory infections.
• Optimize your sleep.
• Reduce your stress.
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 omega-6 oils. All of those things are going to be significantly reduced from your diet.”
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. It took about a year to get rid of the last bit of fat around his belly.”
To learn more, be sure to pick up a copy of Malhotra’s book, “The 21 Day Immunity Plan.” It’s an easy read that emphasizes and summarizes the core lifestyle basics you need to understand and apply to improve your metabolic health, which in turn will reduce your risk of complications should you come down with symptomatic COVID-19 illness. Social Media info for Dr. Malhotra can be found on his site at doctoraseem.com.