Now today we're going to talk about that toxic mix of too much body fat and COVID-19
so a lot of people have seen it there was a family in uh I think New Jersey six or eight
months ago there was a family picture they had a family gathering and there was a lot of obvious
overweight family members there or there were a lot and the rest of the story was right after that
there was a huge amount of death and disability in that family due to COVID what is the issue
with COVID and obesity first of all let's remember and let's think about the common issue we used to
think that body fat was an inert storage tissue that was up until about 5-10 years ago
and now we realize that's not the case at all body fat is a very aggressive hormonal tissue
and that's what we're going to talk about today it's that hormonal response that we
get from body fat that causes this problem as well as insulin resistance as well as so
many other things that we've talked about which are to a large extent that common
pathway for chronic diseases resulting in diabetes prediabetes heart attack stroke dementia you name
it in the early days of the COVID-19 pandemic doctors noticed something about people who became
severely ill that many were obese obesity may be one reason some countries or communities are hit
hard in the US the obesity rate among adults has climbed for decades and is now at 42% the rate's
even higher among black and Hispanic Americans the data shows that even adults with a BMI of 30 to 35
usually will often face far worse outcomes from COVID-19 five times more likely to experience ICU
admission compared to those that are not obese and two times more likely to experience
respiratory failure compared to those without obesity why is obesity a contributing factor well
scientists are still studying the factors excess weight increases the chance of developing
several health problems including heart disease and diabetes along with obesity heart disease and
diabetes are among the conditions that increase a person's risk of severe COVID-19 illness
according to CDC here's an article out of Annals of Internal Medicine obesity and mortality among
patients diagnosed with COVID-19 results from an integrated health care organization
obesity itself increases the likelihood of serious complications the way obesity affects the immune
system may be one of the key factors Sarah Tartof a Kaiser Permanente research scientist speculated
that large amounts of visceral fat play a role in severe COVID-19 fat is not inert it secretes
chemicals that influence bodily systems it affects the angiotensin system that helps regulate blood
pressure and blood flow leading to more severe symptoms although the exact mechanism is unclear
fat and COVID-19 share a common link in the upregulation of pro-inflammatory pro-thrombotic
and vasoconstricted peptide hormones let me translate that body fat and COVID-19 both cause
the immune system to be stimulated and not stimulated in a good way stimulated in a way
where we the host are taking friendly fire from our own immune system levels of anti-inflammatory
adipocytes such as adiponectin and obesity are associated with increased ATII angiotensin II again
let me translate that it's the same as that first sentence body fat COVID-19 caused some
release of hormones which cause inflammation COVID-19 has been shown to cause that inflammation
due to downregulation of inhibition so again you start getting into some logical complications
there but we're always in a balance our immune system is always in a balance some things push us
to get more immune reactions some things push us to slow down that immune reaction things that are
made by our body fat as in adiponectin cause us to increase that immune reaction things made by COVID
the COVID-19 reaction caused us to stop they break down the mechanism which is usually tamping down
that immune reaction so you're getting a lethal combination resulting in a spiraling increase
of this immune reaction it's possible that COVID-19 is able to accelerate pathologic
injuries from existing substrates like ATTII among people with severe obesity Jennifer Lighter NYU
Langone hospital epidemiologist said that people with obesity seem to have more ACE2 receptors
that's the gateway if you remember for the virus that spiked protein links to that could explain
why men are doing worse and why prepubescent children are faring very well in the pandemic
ACE2 receptors the virus infects cells by attaching to ACE2 receptors and that receptor is abundant
on fat cells another study found that the hormone leptin may make them more vulnerable to COVID-19
now that's a risk factor again assuming that it's true when you look at the headline over to the
right obesity the most common comorbidity in SARS- CoV-2 is leptin the link that's what they're
asking you know they're seeing increased levels of leptin and they're going through some of the
potential logic and biological mechanisms leptin regulates metabolism and appetite
and is found in greater amounts in obese people obese people become what they call
leptin-resistant similar to insulin resistance high levels of leptin have been associated with
a type of systemic inflammatory state so here we see again obesity and inflammation
complications in care can arise once hospitalized fat can physically compress parts of the lungs
impeding respiration so here we're talking about just a mechanical problem of ventilating
you know it's like the old Picwikian syndrome you may have heard of it it came from the book James
or somebody remind me the author of that book the English author Pickwick syndrome there was a fella
in his book that was obese and he had trouble breathing because of that obesity his name was Mr.
Pickwick to help with breathing doctors have been putting hospitalized patients on their stomachs
but that can be difficult for the obese making it more likely that they have to be put on a
ventilator calculating medication doses inserting intravenous tubes getting good diagnostic images
and just moving patients around all become far more difficult when you're moving 150 pounds of
fat along with a hundred pound or 150 pound patient because the fat goes along with the
patient now you're instead of 150 you're at 250 to 300 pounds of movement and dosing and imaging
for instance standard doses for painkillers blood thinners and other critical medications usually
stop at certain weights what can be done aside from the steps to slow down the spread of COVID-19
CDC advises the following have a healthy diet good nutrition can support optimal immune
function healthy diet can prevent or support self-management of heart disease type 2 diabetes
obviously be active being active can help boost immune function help prevent diseases and increase
the person's chances of having severe illness from COVID-19 get enough sleep insufficient sleep
has been linked to depression as well as chronic diseases that may increase the risk of severe
illness from COVID-19 you know James has just gotten hooked up with a Freestyle Libre and he's
been having a lot of discoveries we're going to give him a few minutes to share some of those
over the next few YouTube live events because of the importance of understanding our blood sugar
one of the things he and I were talking about yesterday afternoon was I tend to have much lower
blood sugar the nights that I'm sleeping really hard now what does that mean I don't think we
know yet but again it underlines a couple of the unrecognized but very important items in terms of
health our level of blood sugar on a regular basis and our ability to sleep one of the problems with
lack of sleep is that our cortisol levels increase and sure enough if you don't get good sleep one
night you have increased insulin resistance for the next 48 hours and yes that does appear to be
related to cortisol levels those of you who haven't read the book or heard of it it's Why
We Sleep by Matthew Walker is a very very good book entry-level discussion behind the science
of sleep and its impact on health cope with stress I knew an endocrinologist who specialized in
diabetes once who felt like stress was actually the root cause of all diabetes he felt like
his perspective was you know what we live life we get more and more stress on an hourly basis
50 60 years of it and that ends up just resulting in insulin resistance prediabetes diabetes
stress during an infectious disease outbreak can sometimes cause changes in sleep or eating
patterns increased use of alcohol tobacco and worsening of chronic health problems
continue to get great feedback regarding the webinars and here's why you know on the
Internet when you hear a webinar you expect for somebody to try to sell you something
we're not doing that we're trying to tell you something people are coming in with their labs
from Quest inflammation panel OGTT insulin survey response and then they're finding out do I have
inflammation do I have insulin resistance and where does that fit in terms of other folks
we're getting ready to start one for CIMT as well so again people are really
excited about finding out their own status looking forward to seeing you there thanks