Weighty Matters

The primary co-morbidity for COVID-19 infection and adverse outcomes is obesity, which is a persistent pandemic in westernized nations. It's easy to correct.

We are designed to be slim. Fat slows us down. We perform better with less of it. But we are also designed to accumulate fat from time to time. It prepared our ancestors to survive when the hunts were unsuccessful, or edible plants were not in season. We have metabolic flexibility that allows us to operate from fats in our diet or stored in our body, or from carbohydrates in plants. Like squirrels and bears, we feast when the harvest ripens, and store the excess as fat to keep us going until spring. We aren’t made to keep it permanently.

But chronic fat accumulation is unnecessary in our modern age, where all the nutrients we need are available 365 days a year at the local market. And chronic fat accumulation is bad for our health. It causes many illnesses, notably diabetes, but many others. And it diminishes immune health as we have seen in the recent covid pandemic — the overwhelming majority of covid deaths have been among the obese.

There was a time when obesity was rare, and when overweight people tried to lose those excess pounds. Now, most have given up. Being overweight, even clinically obese, has become acceptable.

Most of our “work” is performed sitting at a desk. Our entertainment is mostly watching others do things — vicarious exercise. With the enticements of fattening foods bombarding us in advertisements and supermarket layouts, and the universal expectation of immediate gratification, we have come to accept obesity, even to celebrate it. It’s fashionable. It's considered rude to criticize it. “Fat shaming” is socially unacceptable; being fat is not. It’s why SUVs are popular. Even our coffee is high calorie.

There are many weight loss programs, books, tips and supplements offered in the commercial markets. They don’t work, apparently, as the rates of obesity in modern societies continues to increase. They sometimes work for a while, but then the lost weight returns. Many people come to the conclusion it’s a matter of genes, or fate, or divine command, and the culture adjusts to make it seem fashionable. We all have the power to control our weight at whatever level we choose. It’s a question of making informed choices, and of exercising self discipline more than our muscles.

Then a pandemic comes along and thins the overweight herd. It's nature’s way of warning us.

My Problem

I’ve written here that I’m not a doctor, I’m a patient. But I’m a fairly disciplined patient. I collect and track a lot of measurements of my health. My data shows a fairly dramatic reversal of my weight from a borderline “obese” BMI of 30 in 2012, to a moderately “overweight” 27 when I changed to a vegan diet three years ago. I had achieved moderately “normal” 21 by the time SARS2 began infecting locals in early spring, 2020. It turned out to be very good timing since the patient outcomes indicate a strong correlation between weight and COVID-19 severity.

Weight loss was not my intention, but became a serendipitous benefit of lifestyle changes I made to reverse medical conditions I previously suffered. It was easy. It occurs to me my method might be useful to others.

Phase 1) My weight decreased slowly but steadily after my hip replacement in 2012. The motivation was advice from my surgeon that the implant would last longer if it carried less weight. I simply applied a little bit of discipline, reducing seconds (and thirds), and took smaller portions. I changed to 2% milk on my Cheerios. Lite beer. Chicken breast. Broccoli. Instead of a constantly full stomach, I learned to tolerate mild hunger between meals by reducing snacks. My diet changed from gluttonous to ravenous. BMI from 30 to 27.4 in 6 years. 25 pounds. 38 pants to 36.

Phase 2) I changed my diet from ravenous to vegan in 2018. This change came after several years of escalating abuse by cardiologists, orthopedists, and urologists. I had a procedure to install a cardiac stent (2105), then a second procedure where I won two more (2016). The doctors were pleased but I didn’t like the trend. I started reading and found Greger, Campbell, Esselstyn and others who recommended very low fat. I had to become vegan.

I became very disciplined, tracking every crumb I consumed, but I ate until I was full at every vegan meal. I was never hungry until later in this process when I began experimenting in daily, then weekly fasting. That didn’t affect the trajectory of my weight curve, though. I had a lot of sweet potatoes, brown rice, steamed vegetables, and spinach salads. Beer and donuts are vegan, but I avoided vegan foods with high fat or sugar. I concentrated on foods that provided necessary nutrients. But even broccoli has some fat, so I consistently calculated about 10% fat, per Esselstyn’s recommendation.

It worked to stop the abuse by my doctors. No more stents, nor the angina that caused them, for five years. My heart tests looked good. But I was eating a lot of carbs, and my LDL (“bad“ cholesterol) and triglycerides (”bad” fat) remained high, and my HDL (“good“ cholesterol) remained low. I still needed statins and blood pressure meds. And I had increasing cardiac arrhythmia. My weight finally stabilized at BMI 21.3 when my wife told me I was about right, and I began eating more than I wanted to stabilize my weight. 40 pounds in 2 years. Pants from 36 to snug 32.

The COVID Problem

CDC has reported that obesity is high risk for COVID-19 severity, with an assumption that observed hospitalizations is driven by chronic inflammation which disrupts immune function. Also, obesity is associated with decreased lung function, which is certainly detrimental during an epidemic of lung infections.

CDC data shows that of the COVID-19 diagnoses, 28.3% were overweight (BMI 25-30) and 50.8% were obese (BMI over 30). They estimate that 42.4% of the US population is obese, so the probability that obese people were sick enough to seek medical diagnosis was almost double the population probability of obesity. That’s statistically significant.

Body Mass Index is a calculation of weight as a relationship to height. It can be adjusted for sex and age. There are many calculators available on the internet.

It’s not clear whether obesity itself is the causative factor, or if it is just associated with other conditions that affect COVID-19 outcomes. We’ll probably learn more as research continues to refine our understanding. For now, it’s reasonable to address this condition.

The Fat Problem

A Bing search on “obesity” returns 24,800,000 results. Apparently there is a great deal of interest, but not a lot of success. There are many doctors and clinics specializing in weight reduction, from drugs to surgeries. But diet recommendations focus on “less“ which seldom works. Diet is mostly in the realm of self help books written by doctors with novel techniques. The 42.4% incidence of US obesity demonstrates it’s not working.

Modern medical technology has barely changed life expectantancies, and we still become afflicted with, and die from, the same diseases as out grandparents, and theirs. A major factor has been the increases in obesity that brings a lot of diseases that counter the benefits of improved medical technology. It seems our sickness supports their business model. Why can’t the doctors teach us to avoid those diseases? If they can, why don’t they?

As often happens, the truth is discovered by people outside the medical industry. A thoroughly researched and convincing analysis is provided by Gary Taubes, a journalist, in “Good Calories Bad Calories.” It’s a long and arduous read, but worth the effort for anyone interested in understanding the physiology of fat metabolism and storage. The problem with calorie reduction is obesity actually induces a metabolic preference for storing calories as fat instead of meeting energy requirements of our cells. Taubes concludes that carbohydrates are the bad calories. My experience indicates this is a correct but incomplete conclusion.

Another insight into fat physiology is from Dr Paul Saladino, an MD whose practice is psychiatry, in “Carnivore Code.” His extensively researched analysis shows the risk to many functions of human biology isn’t fat or carbs, but the combination. He shows that the high glucose production from carbohydrate consumption produces insulin, which alters fat metabolism, as well as other problems such as oxidizing fats in the blood that produces arterial plaques and resulting heart disease symptoms.

Phase 3) I changed from vegan with 10% fat to carnivore with 5% carbs a year ago. It has worked well. Another 15 pounds in 6 months. BMI to 19.5. Pants from snug 32 to needing a belt. I’ve maintained that weight for six months.

I feel good, plenty of energy, my HDL is the highest in my records, and triglycerides are the lowest ever. I had switched to carnivore to reduce magnesium wasting that seemed likely on my high oxalate vegan diet, and that successfully eliminated my cardiac arrhythmia. I discuss that in other articles on magnesium and testing.

Many “low fat” diets are considerably higher in fat than needed to reduce the risks for diseases caused by insulin reactions on fat metabolism. “Low fat” is never precisely defined, but analysis of purported low fat diets always calculate 30% fat or higher. The percentages can be calculated for your diet by counting grams of fat, protein, and carbs. Carbs and protein are multiplied by 4 calories per gram, but fats have twice the energy, multiplied by 9 calories per gram, and the three numbers are summed to estimate total calories. The fraction of each nutrient is calculated by dividing the calories in each of the nutrients by the total calories consumed. Since fats have more than twice the calorie energy as protein and carbs, fat has a big impact on the fraction of calories consumed.

Dr Esselstyn in “How to Prevent and Reverse Heart Disease” discloses the statistical error in accepting conventional offerings of low fat foods. They don’t prevent heart disease, and as Taubes shows, they don’t prevent obesity. Esselstyn recommends 10%.

I was happy when I was borderline obese. I assumed my increasingly frequent medical encounters were normal. Ignorance is bliss, they say. But I decided to stop accepting my decline. Improving my diet was a major part of reversing that decline, and also served to reduce my weight a lot. That wasn’t my goal, but was as important for my recovery as the lifestyle changes that caused the weight loss. The weight loss was much easier than it seemed from observing so many struggling with weight reduction. And the results were much better than I had ever hoped.

• Dietary fat is good. Dietary carbs are good. The combination is deadly, and causes the metabolic dysfunctions that cause obesity, diabetes, heart disease, and other chronic conditions.

• “Low fat“ is much lower than medical orthodoxy advises. Standard dietary recommendations allow much higher fat than is healthy.

• Calorie requirements to maintain energy levels are satisfied with greater quantities of carbs than fats, so we are forced to over eat on high carb diets.

• Exercise and sleep are essential for healthy weight. A good diet is essential for having enough energy for exercise, and for quality sleep.