By now, you’ve likely heard that pre-existing conditions, including heart disease and diabetes, contribute to more severe COVID-19 symptoms, complications, and even death. However, media fail to mention that heart disease and diabetes are largely lifestyle-related diseases. They develop over a long period of time as a result of poor diet choices, sedentary behavior, stress, and other daily habits.
This is good news because it means that you’re largely in control of what you eat, how you move, and other lifestyle choices you can make to take back your health and prevent disease. You can always change your habits.
By implementing diet and lifestyle changes that support your body, you strengthen the immune system, prevent chronic disease, maintain a healthy weight, and even reduce your risk of extreme COVID-19 symptoms. This provides you with better defenses against whatever viruses and other pathogens you’re exposed to in the future.
I’m here to tell you that your daily health habits are your best defense against COVID-19. Now is the best time to begin making changes, maintaining those changes, and prioritizing your health.
In this article, you’ll learn about:
- Rates of obesity and chronic disease
- What the research says about pre-existing conditions and COVID-19
- Why we need to focus on preventing chronic disease
- My top five lifestyle tips for preventing chronic disease and COVID-19
Obesity and Chronic Disease
Rates of obesity are increasing in North America and have been trending upward for several decades. Obesity is defined as a body mass index (BMI) of 30 or greater. In Canada, 30 per cent of adults are classified as obese and in the United States, it’s over 40 per cent.
Obesity is a major risk factor for chronic diseases including type-2 diabetes, heart disease, stroke, high blood pressure, cancer, and other conditions. The rates of obesity on our continent are higher than other areas hard hit by COVID-19, including Italy and China.
It’s estimated that around 8 per cent of the Canadian population over twelve years of age have been diagnosed with diabetes. That’s over 30 million people and numbers continue to increase each year. This statistic doesn’t take into account those with metabolic syndrome, pre-diabetes, or those with diabetes that haven’t been diagnosed. The true numbers are likely much more staggering!
In addition, the leading causes of death in Canada are cancer, heart disease, and stroke, making up more than 50 per cent of total annual deaths.
When I take a look at the rates of chronic disease in our country it makes me stop and think.
At the root of this pandemic there isn’t just COVID-19, but chronic metabolic disease fueling the flames of the virus.
Pre-Existing Conditions and COVID-19
Those with pre-existing conditions may need to take extra precautions for avoiding COVID-19 infections, even as public places begin to reopen. To learn more about protecting yourself from novel coronavirus infection, you can read my recent blog on the topic, 'COVID-19 How to Protect and Assess Yourself.'
Here’s a list of pre-existing conditions that may increase the severity of COVID-19:
- Heart disease
- Chronic lung diseases, including COPD, emphysema, and cystic fibrosis
- Chronic kidney disease, especially for those requiring dialysis
- Immunocompromised, including those with HIV, organ transplant recipients, and people undergoing cancer treatment such as chemotherapy
- Liver disease
Although age isn’t a pre-existing condition, we do know that older individuals, especially those over 65, have a greater risk of developing more severe symptoms and are dying at higher rates from COVID-19. This may be because immune function decreases with age. However, it may also be because rates of inflammation and chronic disease tend to increase as we get older, as we practice poor habits over a longer span of time and lose protective lean body mass.
A recent study of 5700 patients in New York City that were hospitalized with COVID-19 showed that 88 per cent had at least two chronic health conditions. (1) The most common comorbidities were hypertension, obesity, and diabetes. In another New York City study, being over 65 years old and obese were found to be the greatest risk factors for hospitalization from COVID-19. (2) Obesity goes hand-in-hand with inflammation and is often a contributing factor to other comorbidities.
In another study of 187 patients with COVID-19, 27.8 per cent had heart complications, which is associated with fatal outcomes. (3) In addition, 35.3 per cent of the patients in the study had underlying heart issues, including hypertension, coronary artery disease, or cardiomyopathy, a heart muscle disease that makes it harder for the heart to pump blood.
This makes sense when we think about the link between the heart and the lungs. The lungs oxygenate the blood and the heart delivers the blood throughout the body. With COVID-19, it becomes harder to breathe, oxygen levels drop, and the heart has to pump faster. An underlying issue with the heart only makes this situation worse.
In addition, it’s important to note that diabetes is often the driver of heart disease as chronically elevated blood sugar damages the heart. A study from Wuhan, China, states that diabetes is one of the most common risk factors for death from COVID-19 and that a staggering 69 per cent of hospitalized patients had ‘non-ideal’ blood sugar levels. (4)
In another report from China, this one involving over 72,000 COVID-19 cases, those with diabetes were found to be three times more likely to die from COVID-19 when compared to overall death rates. (5) This study also reports the death rate from cardiovascular disease to be 10.5 per cent and 7.3 per cent for chronic respiratory disease, compared to a 2.3 per cent overall death rate.
I’m sure as time goes on, we’ll see more data confirming the link between COVID-19 severity and chronic disease.
A Radical Solution: Prevention
There’s a lot of talk in the media about medications, vaccines, and other treatments and while these will certainly have their place when available, the missing piece of the puzzle is prevention.
As an integrative and functional medicine doctor, I’m keenly aware that all body systems are connected and am always looking for the root cause. If one of the root causes of COVID-19 mortality is obesity and chronic disease, then let’s address what’s below the surface. The good news is that diet and lifestyle habits create health, halt disease progression, and in some cases even reverse chronic conditions. Addressing the health of the population is likely to help a huge number of people during this, and future, pandemics.
A recent article published in Obesity states: “Until further breakthroughs emerge, we should remember that modifiable lifestyle factors like diet and physical activity should not be marginalized. Decades of empirical evidence support both as key factors promoting health and wellness.” (6)
Dr. Hoffman’s Top 5 Tips for Chronic Disease and COVID-19 Prevention
- Adopt a whole food diet. This means ditching the processed, high-sugar, and packaged foods in favour of cooking at home. One silver lining of all the shelter in place orders has been that many people are cooking more, which is incredibly beneficial for health. In addition, focusing on eating whole food most of the time helps you to naturally achieve a healthy weight.If you have insulin resistance or diabetes, consider a low carb or keto diet to help manage blood sugar. At the Hoffman Centre for Integrative and Functional Medicine, we often see blood sugar dysregulation in its early stages and are able to course correct before it progresses to diabetes. My team and I are here to help you personalize your dietary approach for your unique needs.
- Move your body. Exercise helps your body and mind to function at its best, is a wonderful tool for blood sugar management, keeps you mobile as you age, and helps to prevent chronic disease. My best advice is to make exercise fun and enjoyable instead of it being a chore. The key is building movement habits into your day and week and I promise, as you move more, it will get easier and your body will naturally want to move.You can read more about my approach to exercise on my blog post, "Exercise Smarter, Not Harder: How to Optimize Your Workout for Your Brain and Body".
- Stress less. Stress contributes to weight gain, inflammation, and chronic disease. Tools such as movement, meditation, neurofeedback, and biofeedback are incredibly helpful to incorporate into a self-care routine. Here at Hoffman Centre, we can help you learn tools to pull your body’s nervous system out of a stressed state and into a relaxed one. When considering stress, it’s important to note that not sleeping enough and exposure to toxins cause stress in the body, along with the typical stressors that we’re familiar with.
- Optimize your vitamin D levels. Vitamin D is incredibly important for proper immune function and deficiency has been linked to a variety of chronic diseases. (7) Vitamin D deficiency is a very common nutrient deficiency, especially here in Canada because of our northern latitude. A recent article suggests that because of vitamin D’s role in reducing respiratory tract infections, supplementation may reduce the risk of COVID-19 infections and death. (8)
- Consider supplements. It takes time to move the needle on your health and while you work to put the foundational pieces of diet, movement, and stress management into place, supplements help to bridge the gap. My team and I support patients with developing personalized supplement protocols for their health concerns.In addition, supplements provide immune support, which may be of particular benefit to those at higher risk for severe COVID-19 infections. Consider vitamin D, vitamin C, zinc, probiotics, curcumin, green tea, and others. The Institute for Functional Medicine released a handout with potentially supportive supplements for both prevention and treatment of COVID-19.
When we look deeper to uncover root causes, we see that poor health and chronic disease not only affect quality of life. It also increases risk of pandemic infections. This connection is empowering because so much of what contributes to, or prevents, chronic disease is completely within our control. It truly is never too late to make changes.
If it feels overwhelming to change your daily habits to improve your health, including upgrading your nutrition and moving your body, start with one small and achievable goal. Once that first habit’s in place, work on the next. Over time, you’ll achieve sustainable lifestyle change and will notice differences in your body and how you feel. Please note that we’d love to support you here at the Hoffman Centre for Integrative and Functional Medicine, so don’t hesitate to contact us for an appointment.
- Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area [published online ahead of print, 2020 Apr 22]. JAMA. 2020;10.1001/jama.2020.6775. Abstract: https://pubmed.ncbi.nlm.nih.gov/32320003/
- Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospitalization and critical illness among 4103 patients with COVID-19 disease in New York City. [Preprint article] medRxiv 2020.04.08.20057794 Abstract: https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v1
- Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Published online March 27, 2020. Full text: https://jamanetwork.com/journals/jamacardiology/fullarticle/2763845
- Zhou J, Tan J. Diabetes patients with COVID-19 need better blood glucose management in Wuhan, China [published online ahead of print, 2020 Mar 24]. Metabolism. 2020;107:154216. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102634/
- Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. 2020;323(13):1239–1242.Full text: https://jamanetwork.com/journals/jama/fullarticle/2762130
- Carter SJ, Baranauskas MN, Fly AD. Considerations for obesity, vitamin D, and physical activity amidst the COVID-19 pandemic [published online ahead of print, 2020 Apr 16]. Obesity (Silver Spring). 2020;10.1002/oby.22838. doi:10.1002/oby.22838 Abstract: https://pubmed.ncbi.nlm.nih.gov/32299148/
- Heaney RP. Vitamin D in health and disease. Clin J Am Soc Nephrol. 2008;3(5):1535‐1541. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4571146/
- Grant WB, Lahore H, McDonnell SL, et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020;12(4):E988. Published 2020 Apr 2. Full text: https://www.mdpi.com/2072-6643/12/4/988/htm
Dr. Bruce Hoffman, MSc, MBChB, FAARM, IFMCP is a Calgary-based Integrative and Functional medicine practitioner. He is the medical director at the Hoffman Centre for Integrative Medicine and The Brain Centre of Alberta specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He is a certified Functional Medicine Practitioner (IFM), is board certified with a fellowship in anti-aging (hormones) and regenerative medicine (A4M), a certified Shoemaker Mold Treatment Protocol Practitioner (CIRS) and ILADS trained in the treatment of Lyme disease and co-infections. He is the co-author of a recent paper published by Dr. Afrin’s group: Diagnosis of mast cell activation syndrome: a global “consensus-2”. Read more about Dr. Bruce Hoffman.