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 goodfoodgreatmedicine.com/resources/resources.htm:
- An Evidence-based Guide to Successful Waist Loss and Preventing or Reversing Insulin Resistance and Type 2 Diabetes
- Control High Blood Pressure
- Cold and Flu
- Concerned about Coronavirus?
David Ellis MD
