Thursday, March 19, 2020

COVID-19: Another reason to reverse your diabetes and high blood pressure

As the COVID-19 pandemic continues to unfold, people tend to focus on their acute risk factors, behaviors, and interactions to avoid exposure.  This make good sense from an individual and public health perspective, but we need to be equally aggressive in pursuing habits and lifestyle changes that will improve not only our overall immunity and strengthen our natural defenses against COVID-19, but also improve our quality of life and longevity.  This approach is especially needed for those with type 1 and type 2 diabetes and high blood pressure.

Many view diabetes as an independent disease of the endocrine system that only encompasses blood sugar and vascular concerns; however, the immune system implications are profound.  Unfortunately, this may be particularly true in the case of coronavirus susceptibility.  In a recent article in Lancet Respiratory Medicine, [1] the authors hypothesized that a specific enzyme elevated in people with diabetes or high blood pressure, as well as those on ACE inhibitor blood pressure drugs, may increase their susceptibility to coronavirus.  Here is the relevant quote for those interested in the technical details:

“Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARSCoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels.  The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs)… These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19.”

This isn’t to suggest that you should stop taking ACE inhibitors: these medications have benefits that are carefully considered by your doctor and sometimes necessary depending on your disease process.  It DOES, however, remind us of the fact that diabetes, and probably high blood pressure, are major risk factors for impaired immunity, and every effort should be taken to vigorously pursue lifestyle measures to reverse type II diabetes and high blood pressure. 

This is a challenging time for our nation and our local communities.  We need to be in a position to help care for our most vulnerable, and that starts with taking good care of ourselves.  As always, Dr. Hassell and I are available (largely via telehealth right now) to advise you in these efforts and answer any questions you may have.

My recommendation:
For a comprehensive plan to reverse type 2 diabetes and high blood pressure, the Risk Reduction Action Plan on pages 90-108 of Good Food, Great Medicine (4th edition) is a good place to start.  You can also download the following evidence-based lifestyle handouts at

  1. An Evidence-based Guide to Successful Waist Loss and Preventing or Reversing Insulin Resistance and Type 2 Diabetes
  2. Control High Blood Pressure
  3. Cold and Flu
  4. Concerned about Coronavirus?  

David Ellis MD