Welcome back to the stay off my operating table podcast with Dr. Phillip Aveda. I'm your co host, Jack Heald. Welcome back. Dr. Oh, it's been a couple of weeks since we've talked.
Thanks, Jack, great to be back with you. And congratulations on your wedding and your honeymoon. Hope you enjoyed that.
I'd been single for 17 years, and I'd forgotten how much I loved being married. It's this has nothing to do with our with the subject of the podcast, although maybe it does, I think I think it's been demonstrated empirically, that happily married people tend to be healthier as well. So
yeah, as you know, one of the, you know, principles behind metabolic health that I talk about is dealing with your stress. And I think, you know, having a happy marriage is a positive way to do that. And, unfortunately, having an unhappy marriage can be a contributor to that. So I would certainly say that happy marriage and metabolic health go well together.
Alright, the subject of this podcast is not how a happy marriage, we'll keep you off doctrove at his operating table, but maybe we'll we will do that Episode Episode sometime. Today, I want to ask you about something that is suddenly near and dear to my heart, I just found out literally less than an hour ago, one of my dearest friends is in the hospital with a nasty case of COVID induced pneumonia. So let's, if you don't mind, let's talk about metabolic health. And COVID. How do you feel about
that? Sure thing, you know, I would say, from the beginning of the COVID, pandemic, epidemic, whatever you want to call it, it was pretty clear, you know, that there were certain characteristics among the patients that were getting sick pretty early. And many of these things were related to
metabolic health. And one of the things that I have been talking about, you know, over the past two years, and many others, you know, have been talking about as well, is how focusing on our metabolic health could help in the sort of dealing with COVID. And I think it would be good for us to get into some details around that.
Well, let's do that. Let's talk, first of all, what are the known risk factors in terms of metabolic health, that put someone at increased risk? For a, let's call it a bad outcome if they contract COVID? And I think it's a foregone conclusion that at some point in the next few years, everybody's going to get COVID? What are the risk factors that that indicates? You're, you're not going to have a good outcome?
Yeah, so I think, you know, if we look at sort of the totality of the evidence that we have now, you know, basically two years into this, one of the patterns that emerge early and has continued on throughout the pandemic is that, you know, the biggest risk factors for people who were getting sick from COVID people who ended up in the hospital, people who ended up, you know, having prolonged courses due to COVID, you know, ended up on breathing machines, all and, and
ultimately, you know, the many who have ended up dying from COVID, one of the, you know, consistent findings has been that these people tend to be older, they tend to be more likely to be obese, more likely to have diabetes, high blood pressure, and these other conditions that we know are related to poor metabolic
health. Now, unfortunately, you know, like we've talked about on this podcast, oftentimes, you know, those conditions like obesity, like high blood pressure, like diabetes, don't get tied back properly to metabolic health, the underlying root cause of these conditions, but we certainly know that these are all markers for metabolic health, these are all things that, you know, come out of being metabolically unhealthy.
So, you know, while unfortunately, you know, I don't think we've made that connection to the root cause of poor metabolic health as we should have. We haven't looked at metabolic health as a sort of viable target for intervention to try and you know, minimize the effects of this panel. EMIC It is clear from the data that we've had all long that being metabolically unhealthy is a major risk factor for developing
COVID. And once you develop COVID for getting sick, you know, and having bad outcomes related to COVID.
Is there any? I realize I'm just throwing this question at you without any forewarning. But is there any research studies data that look at outcomes for metabolically healthy versus previously metabolically unhealthy? Individuals who contract COVID? Or are we all? Are we looking at it all? I realize this is kind of a fluid situation. Yeah.
To know, you know, I think we do have, you know, a fair amount of published data on this. And, you know, just kind of quickly pulling up some articles, for instance, you know, there's one case series that looked at 112 Chinese adults, with COVID-19. And this, this goes back to, I believe, you know, March or February of
2020. So fairly early data. And it basically showed that 88% of the patients who died of those, you know, that group of patients who died, were overweight or obese, versus only 19% of those who survived, that were overweight or obese.
I'm sorry, back up and run that by me again. Yeah.
18% 19% of the patients, okay, survived COVID
were overweight, or were overweight or obese versus
88% of those who died, you know, in this early series of COVID patients were overweight or obese. Okay, so
quick question. Yeah. With an n of 112? How reliable would you as a physician, consider that bet report to be?
Um, so, you know, I would say that's a pretty strong signal there, you know, 88% versus 19% is a is a massive difference, statistically. But you're right, it is a small sample size. You know, it was just a select group. And I don't know the details, how they, you know, pick those patients to look at. So, you know, I wouldn't say this is some, you know, a definitive study. But I think, again, it was one of the early pieces of data that came out
around this. And I think what we saw, you know, when we look at the early outbreaks, if we remember back to, you know, March, February 2020, when we had, you know, the initial data coming out of China, and then Italy, and then New York, were short of the three big Epi Centers, similar data was seen in all of those places, that the patients who were ending up in the hospital, the patients who were ending up on respirators, the patients who ended up dying, you know, the common
characteristics were, first of all being older. And we know that the, you know, the incidence of poor metabolic health, the incidence of metabolic disease, metabolic syndrome increases with age. And then we also saw,
I want to, I want to pause it right there. And just and repeat back to you the incidence of metabolic syndrome increases with age, is that correct? Yes. Yeah. All right. So so can I extrapolate from that, that the older you get, the more important paying attention to your metabolic health becomes?
Yeah, I mean, you know, obviously, as you know, you know, I think metabolic health should be a focus throughout your life. But, you know, you're going to have a higher likelihood of being metabolically unhealthy, the older you are, and therefore, you know, it becomes, I guess it should be more of a focus. The older you are, although, again, you know, I would tell you, it's best to focus on this early so you don't end up in that category. That is getting metabolically more unhealthy as we age.
sure that that certainly makes sense. I just, you know, since since I'm on the back side of the mountain on I'm interested, maybe a little more interested in these things. Alright. I didn't mean to interrupt you. Let's keep going.
Oh, no problem. You know, and I was going to follow that up with saying, you know, there were, there were many other data points, many other studies. that, you know, came to a
similar conclusion. So you know, age, obesity, diabetes, high blood pressure, these are probably, you know, the risk factors that were most apparent early on in this pandemic, and really have carried all the way through, you know, when you look at the people who are ending up in the hospital today, whether or not they're vaccinated or unvaccinated within both groups, we now have data that shows the same risk factors carry through.
So the people who are vaccinated and getting breakthrough infections and getting sick from those breakthrough infections, those same characteristics, you know, come out as risk factors. And again, you know, this mechanistically, you know, makes sense. We know that being metabolically unhealthy, makes you more prone to infections of all sorts of Con, you know, all
sorts. We also know that one of the hallmarks of poor metabolic health is that it causes chronic inflammation in the body, chronic low grade inflammation. And so if you add an acute illness, especially an acute viral illness that seems to, you know, target the inflammatory systems of the body, like COVID, 19, the body's not going to, you know, sort of have capacity to deal with that, if you're already kind of inflamed, and then you add something else that's going to cause more
inflammation. This is the sort of pattern that we're seeing of people who get, you know, people who get very sick from this disease.
I want to, I want to go back, because I'm the I'm kind of the designated dummy here on this show. And make sure I understood what you just said, you've probably said it before. You know how sometimes things just finally sink in? used? I thought I heard you draw an equivalency between metabolic ill health and chronic inflammation is that. Did I hear
that right? And maybe a better way to ask the question is, if I am metabolically unhealthy, and we've defined what that is, in the past, I'm going to ask you to do that again in a minute. But if I am metabolically unhealthy, then at least one of the things that means is that I have chronic inflammation, is that
an accurate statement? Yeah, I think that is an accurate statement. And if you don't
mind, please, please back up again and define for us how you define metabolic health versus metabolic Philhealth.
Right. So you know, again, we have the five basic measures that we tend to look at, you know, to determine who is metabolically healthy and who is not metabolically healthy. And those, you know, markers are your waist circumference, your blood pressure, your fasting blood glucose level, your HDL cholesterol, your good cholesterol level and your triglycerides. What is the
what's the passkey, the fasting blood sugar? What's the what's the boundary there between
the boundary there is 100 milligrams per deciliter. So you want your fasting blood glucose to be less than 100. And that needs to be without the use of medications.
Without without taking medication, the definition of
without the use of glucose lowering medications to meet the definition of metabolic health, but what we see is that patients who are not metabolically healthy, you know, people who have the metabolic syndrome, oftentimes have elevated markers of inflammation. The most common one that I track in my practice, with my patients is something
called C reactive protein. And it's kind of a, it's a general inflammation marker, but it has been tied very specifically to increased risk of heart disease, patients who have an elevated CRP level, have an elevated risk of heart disease. But, you know, again, it's due to that inflammation that occurs, you know, with poor metabolic health, and there's, you know, some I would say, there can be different sort of types of inflammation, different sources
of that inflammation. In a lot of patients, it's within the blood vessels,
that the inflammation inflammation inside the blood vessels inside the blood vessels. Is that Is that where the the That's where the cholesterol builds up inside your your arteries and squeezes things and make sure that pressure go up. Okay? Yeah, well, that was my that was my dad. Okay. Yeah,
how the, you know, cholesterol is a repair mechanism for that inflammation, but the inflammation can occur in the blood vessels, the inflammation can occur, you know, in the intestines, you know, in flat, you know, we many people are familiar with, sort of, you know, what's called leaky gut syndrome, but basically, inflammation of the gut that oftentimes accompanies
poor metabolic health. And that's one of the reasons that we think that, you know, the foods that we are eating are such a strong driver of metabolic disease. And then, you know, for other people, the inflammation shows up in different ways, autoimmune conditions, arthritis, you know, irritable bowel disease, or inflammatory bowel diseases like ulcerative colitis, all of these things, you know, are relatable for metabolic health. And interesting,
Mike, my dad had ulcerative colitis early in his life. And I would have up until this very moment, would have thought coincidentally, his his cardiologist called in my cholesterol creating machine, maybe the two things were related.
Yes, there certainly seems to be a relationship there. Wow. And again, those are, you know, additional risk factors, patients with these autoimmune conditions, these inflammatory conditions are also seem to be
at greater risk from COVID. And, you know, we can make that common link, you know, again, getting back to sort of root causes, we can certainly come up with the linkage there, that, you know, the poor metabolic health that goes along with these autoimmune conditions, is also going to predispose those patients to, you know, problems with COVID.
Alright, so I've got two questions I want to ask, I'm going to ask both now, even though they're not related, because otherwise, I'll forget them. Question number one, can you please repeat the mechanism, as we understand it, that causes people who are metabolically unhealthy to be more susceptible to bad outcomes? If they, if they get COVID? This? You know, what, I will remember the second question, so,
all right. You know, I think there were a number of mechanisms that have been proposed. I don't think we know for sure, and it certainly may be a combination of these. But I would say, you know, some of the basics are that, we know that being metabolically unhealthy, like I said, causes chronic low grade inflammation within the body. And then when we add the inflammatory insult of COVID, on top of that, the body, you know, just gets
overwhelmed. So this cytokine storm that, you know, people talk about around COVID, which is basically, you know, the inflammation system of the body sort of going out of control. You know, that goes along with, with this.
So, I want to make sure I understand so, so, I remembered an online community I'm a part of literally, it was March 2020, when one of the medical professionals first proposed that it was a cytokine storm that was was going on here with COVID. So I want to make sure I'm clear. metabolically unhealthy means that you've already got chronic inflammation COVID triggers an inflammatory response, because that is in fact, how the body fights these kinds of pathologies pathogens.
However, if, if the inflammatory response is triggered in a system that's already under stress from chronic inflammation, that's where we trip over into that cytokine storm. Am I saying that right? Yes. Okay. Yeah, I didn't mean to interrupt you, but um, I'm trying to work through all this. Make sure it's making sense to me,
okay. One of the other you know, kind of mechanistic things that has been proposed between, in between metabolic syndrome and COVID. Is that the ACE two receptor which is the target of the virus? It's basically the receptor on the cell that the virus uses to get into the target cells and interest on
a receptor. Generally, as I understand it is just a molecule that electro chemically bonds with other other molecules based on its I think it's really its shape, but it also has to do with its electrochemical charge, right? My Wiener, right about that. Okay, so as to receptor is a particular molecule that bonds with particular other molecules?
Correct. And, you know, I, the analogy that I like to use for people to think about this is it's sort of the docking station on the outside of the cell that allows, you know, in this case, the virus, in other cases, just proteins, you know, to come into the cells, okay, so the h2 receptor has been shown to be one of the key points of entry for the, you know, SARS virus, the cov, to
virus to enter cells. And we know that patients who have insulin resistance and poor metabolic health have increased numbers of these ace to receptors in many of their tissues, such as in the lung, in the pancreas, other places. So that's another, you know, reason, we think that patients who are in poor metabolic health, you know, may be more susceptible to COVID.
Okay, you're going a little fast for me say that whole bit about increased aistear receptors again,
yeah. So we know, you know, in general, and this has been looked at for other reasons, you know, before COVID, we know that, in animal studies, as well as in human studies, patients who have insulin resistance, which is one of the hallmarks of poor metabolic health have increased numbers of these ace to receptors on, you know, in many different tissues of the body.
Pa, so So there's something that's happening with an excess of with with too much insulin or not enough, not enough insulin sensitivity, that causes the body to respond with increased h2 receptors. Oh, okay. I it, it just clicked. It makes sense to me.
Yeah, again, so that's sort of a cellular level, you know, explanation of, you know, what is likely going on that, you know, causes this increased susceptibility in patients who are metabolically unhealthy.
Now, is there a any kind of connection between inflammation and insulin? Lack of insulin sensitivity?
Yeah, well, again, we know that, you know, patients who are metabolically unhealthy and therefore insulin resistant, or more likely to be inflamed. Again, there might be a few different, you know, ways to look at that a few different reasons to think about that. One of the things is that we know having, you know, high levels of of sugar in the blood, high levels of glucose in the blood is inflammatory, it is damaging, Oh, okay. Does that makes sense?
You know, what, that that is a relationship there.
So if your insulin if your insulin receptors are insensitive to the insulin in your system, and I may be saying this wrong, but I think I've got the basic idea, then what's going to happen is you're going to have excess sugar in your blood. And excess sugar in your blood is in fact inflammatory, it triggers it, it's a lot abrasive to the to the system. And the response of the system to that abrasion is is inflammation, something like
that? Yes. Okay, I think, Alright, so I have this, this other little light bulb that went over my bed just came on over my rather thick skull. I was I made some notes here, as we first began talking that the four things we know are, are tend to be indicators for bad outcome, assuming that you can track COVID Our age, obesity, diabetes and high blood pressure, not a damn thing any of us can do about age short of dying. I mean, if you die, you
won't get any older. So I guess that's one thing we could do, but frankly, I consider that one off the table but the other three being obese. Having diabetes having high blood pressure, those three things all indicate a, if the presence of any, any or all of those three is highly correlated with a bad outcome if you can track COVID. And it's really easy to know if you have one or more of these situations. So obesity, I remember back to I'm just thinking back to our earlier
conversations. If your man, check the circumference of your belly at your just below your belly button, just above what you say, just above your belly, would you say 40 inches,
40 inches for a man 35 inches for a woman is 40 inches
for man 35 inches for a woman, if it's greater than that, you've got a problem, I guess, obesity. And guess for all of those of you who are gonna say actually, we realize these are rough numbers, but and the diabetes, you just could do that fasting blood test thing. And high blood pressure, you literally just get your blood pressure taken. It's super easy to find out if you're at risk with any of these. I'm right, aren't I?
Yes. And, you know, to kind of, I guess, you know, start to wrap this episode up. You know, I think one of the biggest, you know, kind of regrets that I have around how, you know, this whole pandemic has been faced how this whole pandemic has been dealt with, with the medical system and from our public health officials, is that despite the fact that we knew those things, you know, that you just said, we knew what these risk factors were, right from the beginning,
we haven't
done enough to encourage people to try and reverse try and improve those risk factors. You know, the, we could have had better messaging all along to say, you know, if you get yourself metabolically healthy, if you lose your lose weight, you know, eat better deal with your high blood pressure, you will lower your risk of getting this disease and getting sick from this disease.
And we've talked about, you know, lots of other things, lots of other things have been proposed and put out there to try and, you know, deal with the disease. But there has not been enough of a focus on the opportunity to improve our
metabolic health. And that's one of the reasons why I think that two years into this, we don't seem to be making the progress that everyone you know, would like to see, you know, in terms of eliminating this pandemic, because we still have that underlying fact that 80% of the adults in United States and similar numbers worldwide are metabolically unhealthy and therefore are at high risk from, you know, this acute viral pandemic that we're dealing with.
I don't think there's a better way to put a bow on this particular episode than that. This has been the staff my operating table podcast with Dr. Phillip Aveda you can follow Dr. O on Twitter at I fix hearts. You can check out his website where he has a telemedicine practice at OBEDIA heart health.com I'm Jack Heald. We'll talk to you next time.