We are now 2 years into the COVID-19 pandemic and, despite the success of vaccination, cases are rising again. This can still be a serious disease with a risk of long-term complications and even death. Since the very early days of the pandemic, clinical trials have shown that age and obesity are two of the principal risk factors for severe disease and higher mortality. A study published in the June 2021 edition of The Lancet Diabetes & Endocrinology showed that, above a BMI of 23, COVID-19 severity increased in parallel with BMI.
Why Does Obesity Increase The Risk?
There are multiple reasons for the increased severity of the disease in patients with obesity.
- Obesity is associated with other chronic diseases considered to be a high risk for COVID-19, such as diabetes or heart disease.
- The cell receptor the virus uses to infect our cells is more highly expressed (meaning more receptors are present) in individuals with overweight or obesity.
- The chronic inflammatory state associated with obesity can exacerbate the over-reactive immune response to the infection. This response, called the hyperimmune inflammatory reaction or cytokine storm, leads to the organ damage that occurs in severe COVID-19 disease.
Then there are the practical issues of care for patients with obesity who develop severe COVID-19 disease. Patients in coma cannot assist healthcare staff in their postural changes, and prolonged bed rest has a higher risk of causing skin problems in patients with obesity. And all invasive procedures, such as intubation for assisted ventilation and inserting intravenous lines, are more difficult. Lungs can be damaged by the high ventilator pressure needed to move a heavier chest wall.
The diagram below shows the increasing severity of the different stages of the disease. Fortunately, most patients get better during Stage 1 and do not develop more severe disease. In those patients who do progress to Stage 2, a heightened inflammatory reaction develops, leading to symptoms such as shortness of breath. In Stage 3, with very severe disease, the hyperinflammatory reaction can cause organ failure. This is when intensive care with intubation and ventilation becomes necessary. The chronic inflammatory state present in obesity is going to make it easier for this damaging immune reaction to develop.
What Should We Do?
Despite the evidence from clinical trials showing increased risk even in mild obesity, the NHS only considers a BMI above 40 as a criterion for high-risk. The public health bodies have therefore excluded a huge proportion of those living with obesity from the more intensive preventive measures recommended to high-risk groups. This does not mean that, as individuals, persons living with obesity cannot take every opportunity to ensure they reduce their risks:
- Avoiding crowded unventilated environments, especially if many people are not wearing masks
- Healthy diet and lifestyle. Weight loss.
Diet and Weight Loss
The first and most immediately important action is to eat a healthy, balanced diet. My recommendation is to follow a real-food diet, based mainly—but not only—on plant foods, including a wide range of coloured fruits and vegetables (the colours come from different substances in the plants such as antioxidants, vitamins, etc., which support the body systems that fight infection). For people who eat meat and fish, limit red meat intake unless you can be sure of its provenance, preferably eating fish and white meat (chicken, turkey); fish should be eaten 2 or 3 times a week, with oily fish (sardines, mackerel, salmon…) making up 1 or 2 of those servings. This will provide you with the protein your body needs, which is how to lose fat without losing muscle.
Carbohydrates: always use healthy carbs, that is, unrefined carbs from vegetables, fruit, whole grains (wheat, oats, brown rice, quinoa, buckwheat), pulses and legumes, seeds such as chia and pumpkin, and nuts. Be careful not to overdo it with seeds and nuts as they have a lot of calories because of the fats they contain (though in general these are healthy fats). When using prepared foods such as bread or pasta, look for wholegrain/wholemeal varieties. And remember there are now interesting pasta substitutes made of lentil, pea or other unrefined flours.
Fats: This is not the place to discuss saturated versus unsaturated fats. Regarding immune status, the omega-3 to omega-6 ratio is important. Both are essential for immune health, but the typical western diet has excess omega-6, which will tend to increase inflammation. Cutting back on foods with a high omega-6 content, such as soybean products (including products from soy-fed livestock), and increasing your intake of omega-3 (oily fish, nuts, pulses, and seeds such as flax and chia) will help to restore a healthier balance of these fats.
Ultra-processed foods: These foods are typically energy-dense and contain high levels of refined carbs, fats and salt. Most products have a low fibre content and large numbers of chemical additives to adjust taste and texture and to extend the expiry date. Apart from their deleterious effects on metabolism, these foods can have a negative effect on the gut bacteria. The gut microbiome is now known to play a very important role in health, particularly through its effect on immune regulation.
Consider losing weight. Weight loss will reduce the chronic inflammatory state described above, leading to improved general health, a lower risk of chronic disease, and a lower risk of severe COVID-19. But weight loss must be healthy.
What PronoKal Can Offer You
The PronoKal PnK programme is a programme that not only achieves healthy, rapid weight loss, but also treats the chronic inflammatory state associated with obesity.
The PnK Method uses a very low calorie ketogenic diet that switches your metabolism to a fat-burning machine. Because the diet is very low in fat, you burn up your own fat stores rather than fat you eat; that’s what makes weight loss faster. The programme provides the dietary protein and lifestyle advice necessary to ensure you lose fat, not muscle.
You benefit from the energy boost on the keto diet, resulting from the metabolic switch induced by the PronoKal programme.
Full supplementation is provided to prevent vitamin or mineral deficiencies, and extra omega-3 DHA is given to support immune health and turn off the chronic inflammatory state.
In the COVID-19 era, the PnK Method is therefore ideal from multiple points of view:
- rapid weight loss, leading to a faster reduction in chronic inflammation and in the risk of other diseases
- ensured provision of a correct intake of protein and micronutrients
- specific omega-3 supplementation to restore immune health and further reduce chronic inflammation associated with obesity
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