COVID-19: is diet a weapon for protection, survival?

Revised*

By Marika Sboros

You could wait around hoping for a vaccine to fight COVID-19 or you could use a weapon already here, close at hand, in your kitchen.

Some medical doctors believe that it is diet – but not just any diet. It is a low-carbohydrate diet. They say that compelling research shows that low-carb diets treat and prevent the serious underlying conditions that significantly up your risk of dying from the virus.  (*Editor’s note: It has been pointed out that it is more accurate to say that the evidence suggests improved outcomes after – rather than prevention of – infection. )

Chief among these conditions are obesity, type 2 diabetes and cardiovascular disease (CVD), in particular, hypertension (high blood pressure), heart attack and stroke that fall under the medical umbrella of metabolic syndrome.

Doctors call them “diseases of lifestyle”. They define lifestyle disease as a “medical condition or disorder resulting from lifestyle habits”. Diet is a major habit contributing to lifestyle disease.

Globally, expert voices for low-carb diets for protection (from the worst effects of the virus) have grown louder since the pandemic began. So loud, you could be forgiven for thinking that it’s a no-brainer by now. You would be wrong. The claim remains extraordinarily controversial.

The latest authoritative voice raised in support of low-carb is Australian researcher Dr Maryanne Demasi in an editorial in the BMJ Evidence-Based Medicine.

COVID-19 ‘uneasy bedfellows’

Demasi is an investigative medical journalist with a PhD in rheumatology. She is also deputy director of the Institute of Scientific Freedom.

(Scroll down for a link to Demasi’s editorial in full. While you are about it, read another of her articles, this time in Michael West Media. It can appear unrelated but is part of a much bigger pandemic picture. It reveals drug companies and medical journals as “uneasy bedfellows”. Demasi is relatively restrained. Other MDs, however, put it more strongly, calling it a “scandal”.)

In her editorial title, Demasi poses the question: COVID-19 and metabolic syndrome: could diet be the key? She answers in the affirmative and as usual, backs up with solid references.

Demasi doesn’t knock government-mandated social distancing and good hand hygiene. She does say that governments pay “too little attention to the potential impact of diet on health outcomes”. And as she shows, the latest coronavirus (COVID-19) pandemic is no exception.

“Poor diet is the most significant contributor to the burden of chronic, lifestyle-related diseases,” Demasi writes.

Vested interests

She refers to the rapid transmission of this novel virus that has provided “little opportunity” to conduct trials on whether patients with COVID-19 fare better on low-carb diets compared with other diets. What she discretely doesn’t talk about is all the vested interests involved in treatment and protection methods to date. And all the experimentation. Doctors have resorted to using powerful drugs off-label, despite side effects and lack of evidence for both safety and efficacy.

Click here to read: COVID-19: biggest risk is ‘not from the virus’!

 

That’s with the best of intentions to save lives and mitigate suffering. But it’s not surprising given how little doctors really know about effective treatment for this latest coronavirus. And, of course, there’s good reason some have called it an “unknown virus with multiple faces”.

The reality is there is no consensus on how best people can and all should protect themselves from it.

Yet, as Demasi points out, there already is a wealth of robust evidence showing that dietary carbohydrate restriction is a “safe and effective way to achieve good glycaemic control and weight loss”. It also reduces the need for medication in the management of type 2 diabetes.

As well, compared to low-fat diets, low-carb diets are shown to be “superior” for achieving glucose control. They are also more effective at limiting cardiovascular risk factors in the short and long term for people with type 2 diabetes.

Fat protection methods

Thus, the evidence currently supports low-carb, high-healthy-fat (LCHF) diets for COVID-19 protection and possibly even treatment.

Demasi gives all that evidence and more, in her editorial. It includes:

• A US Centers for Disease Control and Prevention report showing that among COVID-19 cases, the two most common underlying health conditions were cardiovascular disease (32%) and diabetes (30%);
• US research showing that hospitalisations were six times higher among patients with a reported underlying condition (45.4%) than those without (7.6%);
• A study showing deaths 12 times higher among patients with reported underlying conditions (19.5%) compared to those without (1.6%);
• UK research showing that two-thirds of those who became seriously ill with virus infection were overweight or obese;
• Italian research showing 99% of COVID-19 deaths in patients with pre-existing conditions, such as hypertension, diabetes and heart disease.

Click here to read: COVID-19 an ancient way to be modern viral pandemics?

 

Demasi explains the mechanism and driver behind the psychophysiology of metabolic syndrome that significantly raises the death risk from the virus. It is insulin resistance (IR). Demasi defines IR as an impaired biological response to insulin, the hormone that regulates blood glucose levels. This dysregulation of blood glucose levels plays “an important role in inflammation and respiratory disease”.

Evidence grows

She also references a study of patients with COVID-19 with pre-existing type 2 diabetes. It showed that those with better-regulated blood glucose control fared better than those with poor blood glucose control.

More major evidence came too late for inclusion in the editorial. It is a multi-centre retrospective study by Chinese researchers, published in Diabetologica on July 10, 2020. It has limitations, as the researchers acknowledge. However, their conclusion is robust: Fasting blood glucose at admission is “an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes”.

Given all of the above, it raises the question just why there is still so much vigorous, vocal opposition to LCHF diets as a shield against COVID-19. Or as Demasi again diplomatically puts it, a “reluctance” in certain quarters to accept evidence on the benefits of low-carb diets in this pandemic.

That underlines the contentious scientific environment in which she writes her editorial – and the BMJ publishes it.

COVID-19 ‘misguidelines’?

Demasi exposes the reason for that reluctance: LCHF diets contradict official dietary guidelines in most Western countries. The guidelines recommend that carbohydrates make up between 45-65%  of total daily calories. They also advocate a reduced (low) fat, high-carb diet that can exacerbate hyperglycaemia.

These dietary guidelines form “the basis of menus in nursing homes and hospital wards where people with COVID-19 and pre-existing metabolic syndrome are undergoing recovery and respite”, Demasi writes.

The guidelines originated in the US and have “far-reaching influence”, as the US-based The Nutrition Coalition (TNC) notes in a press release today. The guidelines are revised every five years and the latest revision came this week.

It’s putting it mildly to say that the TCN is scathing about the weak “science” behind the revision.

Most doctors and dieticians prescribe the guidelines, TNC says. The guidelines also drive the many programs included in the USDA’s feeding assistance division. Therefore, the guidelines are arguably “the most powerful lever on America’s ideas about healthy eating”. Others say that the guidelines deserve to be called “misguidelines”.

‘Weak science’

Among TNC objections to the latest revision of the guidelines announced this week:

• The exclusion of the last decade of science on saturated fats, which cumulatively shows that these fats do not have any effect on cardiovascular or total mortality;
• The exclusion of all the science on low-carb diets (>65 clinical trials);
• The continued use of a “black box” methodology that is not transparent about how data is evaluated or graded and is therefore not reproducible ­– and thus, a hallmark of good science;

However, the signs are not auspicious for any establishment rejection of the latest revisions. Or for any understanding in these quarters of the implications for the many countries globally that slavishly follow the US guidelines.

In the UK, for example, the British Dietetic Association (BDA) endorses conventional guidelines including during COVID-19 pandemic. On its website, the BDA states that no specific food or supplement can prevent anyone “catching” COVID-19.  It also encourages a “healthy balanced diet to support the immune system”.

By that, the BDA means a “healthy and varied diet containing the five main food groups”. In the UK, that diet is the one in the  NHS and Public Health England (PHE) “EatWell Guide”.  The one that British obesity researcher  Dr Zoë Harcombe famously called the “EatBadly Guide“.

Glimmers of scientific hope

Harvard University’s TH Chan School of Public Health issued a press release on April 1, 2020. It advises fruits, vegetables, whole grains, legumes, and nuts, moderate consumption of fish, dairy foods, and poultry, and limited intake of red and processed meat, refined carbohydrates, and sugar.

Still, there are glimmers of robust scientific light. Demasi’s editorial spotlights some:

• A 2018 position statement by Diabetes Australia that reflects “reliable evidence that lower carb eating can be safe and useful” in reducing blood glucose levels and body weight and managing heart disease risk factors, such as raised cholesterol and raised blood pressure;
• Reports from American Diabetes Association in 2019 and Diabetes Canada in 2020 endorsing low-carb diets as viable options to improve glycaemia and the potential to reduce medications for those with type 2 diabetes;
• Leading medical institutions, including a US-based hospital in West Virginia and in the UK, the Tameside Hospital in Manchester, openly supporting the link between diet and chronic disease.

Another welcome signal of scientific sanity is sponsorship by the prestigious John Hopkins Hospital of a planned clinical trial that takes low-carb diets to their logical conclusion concerning COVID-19.

Keto diets

In September 2020, Researchers will test the hypothesis that the administration of a ketogenic (very-low-carb, very-high-healthy-fat) diet will improve the outcome for COVID-19 patients who require mechanical “ventilation” (assisted breathing).

Which brings us to Demasi’s conclusions in her editorial:

Dietary carbohydrate restriction is “a simple and safe intervention which results in rapid improvements in glycaemic control”, she writes. It can also be implemented alongside usual care in a medical or domestic setting. The pathophysiology of COVID-19 is multifactorial but insulin resistance is among the strongest determinants of impaired metabolic function.

She calls on governments and policymakers globally to adopt and endorse the dietary advice for people with underlying metabolic syndrome as proposed in the UK.

This will go a long way to “mitigate the burden of pre-existing metabolic disease in those who contract COVID-19, now and into the future”, Demasi says.

• Click here to read Demasi’s editorial in full.
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