What is different between individuals infected with COVID-19 who have mild cases and those that develop life-threatening illnesses? Is underlying inflammation a critical factor in determining mild, moderate, or severe COVID-19 symptoms?
I have been interested in medicine for many years. I began reading medical journals in graduate school in the mid-1980s. Later I became a volunteer Emergency Medical Technician for five years with my local rescue squad. I spent my career working in the information technology side of healthcare, with a passion for understanding health and disease. I am not a doctor, but rather, someone genuinely interested in medicine.
Since late 1999 I have followed an ultra low carbohydrate diet after being diagnosed with Type II diabetes. At the beginning of my low carb journey, all I cared about was normalizing my blood sugars. My A1C, a measure of average blood sugar over thirty days, has consistently been between 5.2 and 5.3 for the past twenty years.
An A1C above 5.7 is considered pre-diabetes, and an A1C over 6.5 is full-blown diabetes. My numbers are in the non-diabetic range consistently. But, eat something sweet, and my blood sugar will still rise to unacceptable levels. It is only by strict adherence to a low carbohydrate diet and small doses of diabetes medication that keeps my blood sugars in the normal range.
In the last ten years, I began to read that low carbohydrate diets which eliminate all grains, starches, most fruits, and sugars were considered anti-inflammatory. An anti-inflammation diet is touted to reduce the risk of many modern diseases.
Recently I went to a cardiologist. I was not experiencing any symptoms. Instead, I wanted to establish a heart baseline now that I am in my early 60s. I wanted to begin annual heart checkups since heart disease runs in my family. The doctor and I got into an interesting discussion. She stated that because of my diabetes, I needed to be on a statin. I told her I had no intention of taking a statin, given the side effects like leg cramps and my research showing the limited positive results of taking the drugs. She told me she would agree with me only if I had a CT scan for a coronary calcium score test.
A coronary calcium score test shows the amount of coronary artery calcium residing in coronary artery plaque and is a risk predictor for a heart attack. The test is scored from 0, no plaque, to over 400+, a high risk for having a heart attack. The doctor was sure that the coronary calcium score test would prove that I needed to be on a statin. She implied that because I am a diabetic, it was unlikely I would have a low score. I explained to the doctor that I had been on an ultra low carb diet for over twenty years and had incredibly well-controlled blood sugars. She was not persuaded. “Have the test,” She said, “and then I will call you up, and we will have a conversation.”
I had a coronary calcium score test. My score was 5, which essentially means almost no plaque and a very low risk for a heart attack. I never heard from the doctor again. She never called me to review the results.
As I understand plaque build-up, it is tied to inflammation in the body. My low coronary calcium score implies that my low carb diet is successfully able to keep inflammation at bay.
Is there a connection between inflammation and the degree of illness between COVID-19? In a New York Times article a few days ago titled Obesity Linked to Severe Coronavirus Disease, Especially for Younger Patients, the author, Roni Caryn Rabin, linked inflammation to why being overweight puts individuals at higher risk for more severe COVID-19 illnesses. She writes, “Obesity is known to cause chronic, low-grade inflammation and an increase in circulating, pro-inflammatory cytokines, which may play a role in the worst COVID-19 outcomes.”
I was fascinated by this sentence, which was written almost in passing and never gone into deeply. Could the link between underlying inflammation and severe COVID-19 outcomes be what separates the mild from the worst cases?
I was also interested that the author said, “increase in circulating, pro-inflammatory cytokines.” If you have been following the news about COVID-19, you have likely heard the term, cytokine storm. A cytokine storm results in the lungs filling with fluid and the need for respirators. Could the connection between pre-existing low-grade inflammation and a cytokine storm in the body be important?
I am also interested in how to keep myself healthy and alive through the pandemic. Will my anti-inflammation diet, exercise regime, and overall good health, even though I am diabetic and in my early 60s, make a difference regarding COVID-19? The simple answer is that I believe so, but do not want to test out my theory.
One of the most vivid scenes in the documentary, Food, Inc., showed a cow with a hole cuts in its side. The documentary attempted to show how, when the cow was fed corn, it made the cow sick. Why do we accept that cows were meant to eat grasses and that eating corn makes them sick, but we do not think about human food in the same way?
I have read that the people most likely to develop the severe forms of COVID-19 are those with pre-existing illnesses and the elderly. This is often written about as tied to weakened immune systems in the individual. I would like to see more written about the connection between underlying inflammation and COVID-19 outcomes.
Any analysis of the connection between inflammation and COVID-19 should also explore what exactly makes for low inflammation in human bodies.
Does wheat, grain, and sugar, as many have written, cause inflammation in the human body, and could that inflammation make COVID-19 outcomes worse?
Will an ultra low carb diet offer some kind of protection against the worst of COVID-19?
Could a low inflammation diet really help you survive a pandemic?