Are COVID deaths caused by poor metabolic health?

Why did the Laker's nutritionist blame vegetable oil for the COVID death toll?

A friend of mine recently sent me a clip of the Laker’s team nutritionist, Dr. Cate Shanahan, being interviewed on Bill Maher’s show where she made the claim that anyone under the age of 65 who became seriously ill from COVID-19 has poor metabolic health.

It is not an exaggeration to describe her position as blaming thousands of deaths from COVID on diet and lifestyle choices.

During the interview, Dr. Shanahan fingers two major culprits - sugar and seed oil - that she believes are responsible for the epidemic of obesity, inflammation, and metabolic dysfunction - and the resulting deaths from COVID - that we have seen in America.

I’m going to make the discussion of COVID and metabolic health a multi-part newsletter so that things don’t get too long. Today will be an overview of what metabolic health means and how you can evaluate your own.

Later on, I’ll take a closer look at some of Dr. Shanahan’s claims on the contribution of diet to COVID deaths, with a particular focus on her villification of seed oils (including identifying what the hell seed oil is).

Metabolic health sounds a bit like woo-woo nonsense. What does it actually mean?

Metabolic health is sort of an amorphous term that people in the wellness world frequently throw around without a precise definition.

Good metabolic health can be thought of as the absence of any of the markers of metabolic syndrome.

Metabolic syndrome refers to a constellation of several medical findings that increase risk of things like diabetes, heart disease, and cancer. Metabolic syndrome is generally defined as having 3 out of 5 of the following findings:

  • Abdominal obesity

  • Elevated triglycerides

  • Low HDL cholesterol

  • High blood pressure

  • High blood sugar

You may have heard the term “insulin resistance” before, which is thought to be a crucial part of the biology of metabolic syndrome. This means that you require more and more insulin to keep your blood sugar under control because your cells are resistant to insulin’s blood sugar lowering effect.

This is a precursor to diabetes, which only develops when you can’t make enough insulin to adequately lower your blood sugar. The harm from diabetes isn’t just related to high blood sugar.

The high insulin levels - medical term: hyperinsulinemia - have biologically harmful effects even if you’re able to control your blood sugar.

Metabolic syndrome - the string theory of chronic disease

Metabolic syndrome is probably a contributing factor in a huge proportion of the chronic diseases that plague the modern world.

Almost everything that we consider a “pre-existing condition” can trace some of its biologic roots to metabolic syndrome.

Risk for things like hypertension, diabetes, osteoarthritis, GERD, peripheral vascular disease, gout, coronary artery disease, heart attack, and stroke are all increased by metabolic syndrome. So are many types of cancer. Even dementia, particularly Alzheimer’s, seems to have an increased risk for those with metabolic syndrome.

What is it about metabolic syndrome that’s so bad?

To oversimplify a bit, most of the harmful effect comes down to the effects of high levels of insulin and dysregulated inflammation. These factors increase risk of cardiovascular disease, cancer, and fatty liver.

As I had written about in a previous newsletter, the accumulation of visceral fat - the fat around your internal organs, rather than the fat beneath your skin - tends to be the driver of metabolic dysfunction. This is why we consider waist size to be part of the metabolic syndrome definition: because it’s reflective of fat around your internal organs.

How can I tell if I have metabolic syndrome?

Well, the simplest way is to look at the factors listed above - waist size, cholesterol numbers, blood pressure, blood sugar - and see if you fit. But metabolic syndrome is a continuum, not a binary yes/no condition.

And if you look hard, you start to see it everywhere.

According to researchers from UNC, only 12% of American adults do not meet any metabolic syndrome criteria. In other words, less than 1 in 8 American adults has optimal metabolic health.

In many patients, the presence or absence of metabolic syndrome is obvious. But the hints of developing metabolic dysfunction are present in lots of people who would otherwise seem “healthy.”

When I’m evaluating patients, I pay partiuclar attention to their cholesterol panel to see the ratio of triglycerides to HDL cholesterol. The cutoffs for metabolic syndrome are triglycerides over 150 mg/dL and HDL of under 40 mg/dL for men and 50 mg/dL for women.

But these cutoffs only tell us part of the story.

The ratio is really important. Optimal triglycerides/HDL ratio is under 1:1. The higher that ratio becomes, the more worried I get. If that ratio starts to be more than 2:1, I really worry about metabolic syndrome even if the formal criteria aren’t met.

If you really want to get into the weeds, you can look at other, more specialized, blood testing - things like fasting insulin levels, high sensitivity C-reactive protein, uric acid, and fibrinogen all give insight into underlying metabolic health. But for the majority of people, you can develop a decent assessment without doing more than “standard” bloodwork.

More to come on metabolic health and its COVID implications down the road.

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