The Elephant in the Covid Room

Every single day for the last several months, Australians and New Zealanders have been implored by public health officials, State Premiers and Prime Ministers to get vaccinated against Covid-19. And rightly so, as it’s abundantly clear from the data that the vaccines are very effective at preventing hospitalisations and death.

Notwithstanding this good advice, there is also poor advice by way of omission.

The huge elephant in the COVID room is that our health officials and politicians are neglecting some very powerful lifestyle-driven factors that have the potential to have an enormous impact on both individuals and the ability of the health system to cope.

In a world now endemic with the SARS-COV2 virus, the long game is that it is clear everyone will eventually be exposed to this virus. The Oxford Vaccine team advising the UK Government on their strategy, recently said that everyone will catch COVID and the Australian Federal Health Minister, Greg Hunt, said the same thing on 2CC radio on the 19th of October 2021.

Given this inevitability, then we must consider what we already needed to face long before this pandemic started – that we already have a long-running pandemic of preventable chronic disease which robs us of quality and quantity of life. Our modern lifestyle, characterised by an ultra-processed diet, sedentary behaviour, high stress levels, poor sleep and resulting diabetes and cardiovascular problems are a massive public health problem and still the major cause of ill health and early death in both Australia and New Zealand.

What we now know is that metabolic health, especially control of blood sugar, overwhelmingly predicts how we will fare when we contract COVID-19.

Here are some of the ‘elephant in the room’ statistics regarding personal health and COVID outcomes:

• A whopping 40 per cent of all COVID-19 deaths in the USA (the richest data) are from people with diabetes and one in five diabetics with COVID-19 die within 28 days of admission to hospital. A paper published in July 2021 in Frontiers in Public Health used machine learning to analyse data from 240,000 scientific articles and found that high blood glucose was the number one predictor of a severe disease outcome. This means that non-diabetics who have high or high-normal blood glucose are also highly vulnerable.

• A 2021 study published in the British Journal of Sports Medicine, involving over 48,000 people, reported that sedentary individuals who caught COVID-19 had more than double the risk of hospitalisation and two and a half times the risk of death, compared to people who met the physical activity guidelines of at least 150 minutes of exercise a week.

• A study involving 8,300 UK adults found that people who took a Vitamin D supplement daily or weekly were 34 per cent less likely to catch COVID than people who didn’t and a study published in the scientific journal Nutrients in late 2020 reported that people who were Vitamin D-deficient had a 6-fold increased risk of severe disease and a staggering 15-fold higher risk of death from COVID, compared to those who had adequate levels of Vitamin D. Although this was a small observational study, at least 14 other observational studies have confirmed the association between Vitamin D deficiency and severe disease outcomes. This is of particular concern given that, due to the success of ‘slip slop slap’ campaigns in this part of the world, 23 per cent of Australians and more than 30 per cent of New Zealanders have sub-optimal levels of Vitamin D, and levels are lowest at the end of winter.

Why are we not actively talking and investing in helping people become metabolically healthy, especially resolving their type 2 diabetes? More than ever, we could and should be motivated to treat this, and the lifestyle behaviours that influence these conditions, as a public health emergency and investment priority.

One likely reason for no action is that our public health officials and elected representatives do not want to dilute the message around vaccinations, and we get that.

However, a second reason, and big elephant in the room, is that our health care systems are the polarised opposite of promoting good health. Cynically but accurately, we have a sick care system. In both countries, less than 1.5 per cent of all health care spending is on prevention, with the overwhelming majority being on treatment (the one exception to this is when it comes to COVID vaccinations).

Every country in the world has to face the fact that COVID will be a disease we have to live with. In a world where we really have very little idea of the long-term efficacy of vaccine induced immunity, we must as a matter of urgency, take action to work on the obvious and clear path to living long and healthy lives. Getting active, eating well, getting a good night’s sleep, managing chronic stress, moderating alcohol consumption, reducing tobacco use and reversing our poor glucose control are all the mainstays of human health, including COVID outcomes.

To that end, here is our five-point COVID-resilience plan for people:

1. Get vaccinated

The data is clear and enough has been said on this.

2. Food is medicine: Manage your blood sugar

If your blood glucose is high, or even high-normal, we suggest that you get it under control, and do it quickly. By far the most effective way to do this is to go on a low glycaemic load (ketogenic whole food) diet for three to six weeks and watch your blood sugar plummet and potentially reverse your diabetes. If you can’t be that strict then at least aim to eliminate ultra-processed food. Ditch the sugary treats, bread, pasta, rice, pizza, breakfast cereals, in favour of foods that have low levels of human interference.

3. Fitness is medicine: Be active

Physical activity is a powerful activator of gene expression and helps every single system in the body, including the central nervous system (brain) and the immune system. It switches on anti-oxidant and anti-inflammatory genes and has widespread positive effects throughout your body and brain, and helps to manage blood glucose. It will also help fight off lockdown-induced anxiety and depression and positively impact upon your sleep and immune function.

4. Sunshine is medicine: Boost your Vitamin D

Without a doubt, vitamin D is one of the most important vitamins for your health, especially when it comes to Covid. Vitamin D regulates the expression of more than 2,500 genes and the active form of Vitamin D acts as an important hormone and modulator of both innate and adaptive immunity. The easiest way to get Vitamin D up is to get outside and get some sun. Don’t get burnt of course. You might also consider a supplement, as a 2017 meta-analysis showed that Vitamin D supplementation protects against respiratory tract infections. Aim for 3000-5000 iu per day of vitamin D3 in supplement form for 4 weeks to boost your levels, and then you can drop to 1000 iu a day for maintenance.

5. Sleep is medicine: Get serious around sleep

if you want your immune system to function properly, then good sleep hygiene practices are critical. Try to go to bed at the same time every night and wake up at the same time every day (even on weekends) to ensure that your circadian rhythms are regular. Ditch the caffeine after midday (it’s a brain and central nervous system stimulant) and minimise your alcohol (challenging during lockdown, we get it!). Do some exercise every day, ideally outside, as this will make you sleep better as well (see above).

If you’d like a deeper dive on the subject, check out the podcast by Paul and Grant on the subject at The MindBodyBrain Project Podcast.