In the top 10 leading causes of death listed by the Centers for Disease Control and Prevention, diabetes and high blood pressure contribute to or are the cause of five — heart disease, stroke, Alzheimer's disease, diabetes and kidney disease.1 In 2017, the American College of Cardiology and the American Heart Association redefined the parameters for high blood pressure.2
The change wasn't arbitrary. It was based on data showing that people with blood pressure measurements once considered normal were experiencing some of the same health complications as those who had high blood pressure.
When the new high blood pressure marker was lowered from 140/90 to 130/80, the American Heart Association estimated the number of people with high blood pressure jumped from 32% of the U.S. population to 46%.
This change was similar to a 2004 move by an international committee of experts who lowered the diagnosis of prediabetes from a blood glucose of 110 mg/dl to 100 mg/dl.3 As one researcher writes in Diabetes Care:4
"In the past it was thought that the cut point for diabetes represented a precise threshold of risk for microvascular complications, but it is clear that no such thresholds exist."
In 2018, there were 34.2 million in the U.S. with diabetes, according to the American Diabetes Association. Of these, 26.8 million had been diagnosed and 7.3 were estimated to be undiagnosed. As with many chronic conditions, diabetes is found more frequently in older adults.
Out of the 10.5% of the overall population with diabetes or prediabetes, 14.3 million people over 65 have one of the two chronic conditions.5 However, the overall numbers may be higher since data from 2019 showed that 87.8% of the U.S. population were metabolically inflexible,6 indicating some degree of insulin resistance,7,8 the hallmark of diabetes.
High Blood Pressure Increases Risk of Dying From COVID-19
Doctors in China quickly realized after beginning to treat patients with COVID-19 that nearly half of those who were dying also had high blood pressure (hypertension).9 Researchers used retrospective data from a hospital dedicated only to the treatment of the infection in Wuhan, China, to evaluate the association.10
An analysis of 2,877 patients was done; this included 29.5% of whom had a history of high blood pressure. They found that those with high blood pressure had double the risk of dying compared to those who didn't. This included patients who had a history of high blood pressure but were not taking any medications.
Reports from other countries have also shown that people with high blood pressure are at higher risk from COVID-19.11 In the past it's been suggested that ACE inhibitors, which are medications to treat high blood pressure, can increase an individual's risk of severe disease.
More recent research has shown this is not the case.12 This is supported by a recent study published in the European Heart Journal. Scientists found the death rate among individuals using medications that affect the renin-angiotensin-aldosterone system inhibitors (RAAS), which include ACE inhibitors, are similar to those who do not take RAAS inhibitors. The researchers concluded:13
"While hypertension and the discontinuation of antihypertensive treatment are suspected to be related to increased risk of mortality, in this retrospective observational analysis, we did not detect any harm of RAAS inhibitors in patients infected with COVID-19."
As reported by Reuters,14 the researchers were surprised the results of their analysis showed a trend in favor of patients using ACE inhibitors. They included their data with past studies and found a blood pressure medication may be associated with a reduced risk of mortality.
Diabetes Increases Your Risk of Severe COVID-19
A second comorbidity with an increased rate of severe disease and mortality is diabetes. Researchers gathered data from the National Health Service England to characterize the features of U.K. individuals who may experience severe COVID-19.15
The information came from 166 hospitals from February 6, 2020, to April 18, 2020. The researchers used a preapproved questionnaire from the World Health Organization that reported many of the study participants were also enrolled in other clinical trials and interventional studies.
The data showed the median age of individuals hospitalized for COVID-19 was 72 years with a hospital stay of about seven days. The most common comorbidities were chronic heart disease, diabetes and chronic pulmonary disease.
Thus far, it's been unclear as to whether people with diabetes are more likely to get infected, but what is clear is that a disproportionate number with diabetes are hospitalized with severe illness. It's been estimated that 6% of the U.K. population has diabetes,16 but data from the NHS England showed that 19% of those hospitalized had diabetes,17 which is nearly three times the number in the general population.
It's also important to note that while people with Type 2 diabetes have double the risk of dying from COVID-19, people with Type 1 diabetes are 3.5 times more likely to die from the virus than people without diabetes.18
In another study of 174 patients, scientists found that those with diabetes had a higher risk of severe pneumonia, excessive uncontrolled inflammation and dysregulation of glucose metabolism.19 They concluded that their data supported the idea that those with diabetes may experience a rapid progression of COVID-19 and that they will have a poor prognosis.
Early Data Suggest Baldness May Predict COVID-19 Severity
One team from Brown University believes the reasons behind certain people being hit harder by the virus may be a function of androgenic activity, which has to do with male hormones. The team conducted two studies in Spain.20
In the first, they evaluated the results of 41 Caucasian males who were admitted to the hospital with bilateral pneumonia and who were positive for SARS-CoV-2. In this group, 71% had clinically significant androgenic alopecia (AGA).21
The prevalence of AGA in Spanish Caucasian males is unknown; however, the researchers expected a prevalence of up to 53%. In this study, the researchers only visually diagnosed AGA and did not speak with the individuals. They hypothesized that if AGA could be confirmed as a risk factor, then an anti-androgen therapy may help reduce the severity of symptoms:22
"… recent attention to the anti‐malarial drug hydroxychloroquine is of interest. Chloroquine phosphate, an analogue of hydroxychloroquine, has been demonstrated to reduce testosterone in rodents … Although the data supporting the use of hydroxychloroquine for treatment of COVID‐19 is limited and the potential negative side effects in COVID‐19 patients are unknown, the connection to androgens may prove important."
Recognizing the initial study had a small sample size, the research team undertook a second analysis of data that were published in the Journal of the American Academy of Dermatology.23 In this study, a dermatologist diagnosed AGA in a cohort of 175 individuals, 122 of whom were males and 53 of whom were females; 79% of the men had AGA and 42% of the women had it.
It's important to know that the median age of the women was 71, whereas with men it was 62.5 years. Again, the researchers found a substantial percentage of people in the hospital with severe disease had AGA.
AGA is also known as male pattern baldness, and in women it's called female-pattern hair loss.24 Diagnosis is made on a history and examination evaluating for risk factors, which include advancing age, polycystic ovary syndrome, insulin resistance and prostate cancer.
Insulin Resistance the Underlying Trigger
The underlying factor common to each of these chronic health conditions associated with severe COVID-19 is insulin resistance. The researchers from Brown University acknowledge their patient population included older adults, who are known to be at higher risk of severe disease.
In other studies, researchers have identified obesity as a prominent risk factor, as it doubles the risk of hospitalization in people under 60 with COVID-19.25 While obesity is at the top of the list, another investigation shows individuals with more severe disease have more than one underlying health condition.
A study involving 5,700 New York City patients26 produced results showing that the most common comorbidities were high blood pressure,27 obesity28 and diabetes, all of which are related to insulin resistance. In the study group, 56.6% had high blood pressure, 41.7% were obese and 33.8% had diabetes.
In the group of patients who died, the researchers found that those who had diabetes had a higher likelihood of being on mechanical ventilation or placed in the ICU compared to those who did not. Interestingly, those who had high blood pressure were less likely to have been on a ventilator or in an ICU before they died, compared to those who did not have high blood pressure.
Higher glucose levels, a hallmark of Type 2 diabetes, insulin resistance and metabolic syndrome, appear to play significant roles in viral replication and the development of cytokine storms, which are known to occur in severe COVID-19. For further discussion and more information, see "The Real Pandemic Is Insulin Resistance."
Restore Your Insulin Sensitivity to Reduce Long-Term Risk
It appears that people have come to accept the growing number who suffer from high blood pressure, diabetes and cardiovascular diseases as a normal part of living in Western society. However, these chronic diseases are not normal at all, regardless of age.
To survive the next pandemic, whatever that might be, improving public health must be the priority. It's unreasonable to wait for a drug or vaccine to cure what your body can naturally fight. Instead of throwing drugs at symptoms, it's time to address the underlying causes of illness and disease.
Supporting a robust immune function is necessary to effectively combat COVID-19, flu, the common cold and most other infectious diseases. Addressing insulin resistance is the key to reducing chronic disease and improving health.
To do that, it's necessary to dramatically cut down on processed foods and increase the amount of whole foods eaten. Dr. Sandra Weber, president of the American Association of Clinical Endocrinologists, commented in the New York Times:29
"We know that if you do not have good glucose control, you're at high risk for infection, including viruses and presumably this one [COVID-19] as well … [improving glucose control] would put you in a situation where you would have better immune function."
For details on what and when to eat to reverse insulin resistance, see "Want to Defeat Coronavirus? Address Diabetes and Hypertension." In that article, I also summarize several key strategies for getting and staying healthy and metabolically fit. For additional COVID-19 remedies and top tips, see my Coronavirus Resource Page.
If you'd like a more in-depth understanding of how to become metabolically flexible and eliminate insulin resistance, consider getting a copy of my book. "Fat for Fuel." It goes into detail, providing a comprehensive program to help optimize metabolic flexibility and strengthen your immune system. Both are crucial components of health and disease prevention.
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