Modifiable Risk Factors and Comorbidities for Severe COVID-19 Infection

Modifiable Risk Factors and Comorbidities for Severe COVID-19 Infection
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There are things you can do right now to reduce your risk of falling seriously ill and dying from this disease.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The severity of COVID-19 varies widely based on pre-existing conditions. Those with high blood pressure are at twice the odds of suffering a severe course, and those with cardiovascular disease have three times the odds. What’s more, those with either condition are about four times more likely to end up in the ICU. Those with COPD—chronic obstructive pulmonary diseases, like emphysema—appear to be at the highest risk, with six times the odds of a severe course for COVID-19, and nearly eighteen times the odds of an admission to the intensive care unit.

We know that exposure to air pollution can increase susceptibility to respiratory viral infections, and that may be the case with COVID-19 as well, as higher pollutant levels appeared to be correlated with pandemic deaths. But just as air pollution may influence COVID-19, COVID-19 may be influencing air pollution. Check out this satellite data from NASA. This is nitrogen dioxide pollutant levels before the pandemic, then after lockdown. Here’s what ground zero, Wuhan province, looked like at around this time last time last year, and then post-pandemic. Ready for some irony? The decrease in air pollution following the quarantine is so great that the COVID-19 pandemic might paradoxically have decreased the total number of deaths by drastically decreasing the number of fatalities due to air pollution, averting as many as 30,000 deaths a month in China. In other words, the air quality in China was so bad that COVID-19 may have ended up saving lives—like 1,000 lives a day!

A history of smoking is a risk factor for disease progression, though, surprisingly, active smoking may or may not be. This seeming paradox may provide a clue as to why those with high blood pressure appear to be at higher risk.

It’s easy to imagine why those with heart disease are at higher risk of crashing from COVID-19. Even without direct heart damage, lung infections can put a tremendous strain on the heart. Up to nearly 30 percent of patients hospitalized for regular pneumonia develop cardiovascular complications. About one in 35 suffer cardiac arrest, and those who don’t are still at four times higher risk of a heart attack or stroke within the first 30 days after being released from the hospital. Okay, but why is just having high blood pressure a COVID-19 severity risk factor?

Under certain circumstances, those hospitalized for regular pneumonia with hypertension may do even better. Investigators speculated this may be due to the anti-inflammatory effects of a common class of high blood-pressure drugs called ACE inhibitors (like lisinopril, for which there are more than a hundred million prescriptions dispensed annually in the United States alone). Super common drugs. And, indeed, people on those drugs not only appear to be less likely to die of pneumonia, but they seem to be less likely to even get pneumonia in the first place. Ironically, this same reason why those with hypertension may be protected from regular pneumonia may also be the reason why those with hypertension are at greater risk from COVID-19.

ACE-inhibitor drugs may be anti-inflammatory, but they may also upregulate the expression of ACE2, which, as you may remember, is the enzyme the COVID-19 virus spike protein latches onto in our lungs to infect our cells and spread. So, perhaps the reason those with hypertension seem to be doing worse is that so many of them are on this class of drugs, which may be making them more susceptible to viral attack.

ACE2 expression is increased in some of these comorbid conditions, but the drug connection has yet to be verified.  So, more evidence is urgently needed to confirm the relation—if any—between these high blood-pressure drugs and COVID-19. In the meanwhile, here’s a flow chart that can help guide your doctor. Should we be holding all the ACEs? Well certainly, those on these drugs for heart failure or severe or uncontrolled hypertension should continue on these drugs. (When ICUs are overwhelmed is definitely not the time to have a stroke.) However, the majority of people taking these drugs do so for treating well-managed mild hypertension, and for these patients, physicians may want to consider temporarily discontinuing them for those at high risk of contracting COVID-19, until we know more. As always, you should never just change or stop taking medications on your own without guidance from your prescribing practitioner.

Those of you who follow me on social media know that early on I recommended that people consider not taking ibuprofen unnecessarily, as it is another drug thought to boost ACE2 expression. While the concern again remains theoretical, no drug is completely benign. (NSAID drugs like ibuprofen cause intestinal lining damage in as many as 80 percent of users, for example.) So, no drug should be taken unnecessarily. Furthermore, NSAID use (ibuprofen use) is strongly advised against in lower respiratory tract infections, as it has been associated with higher complication rates in both children and adults with pneumonia. In fact, fever may actually be beneficial in COVID-19, and probably shouldn’t be routinely treated by any means. If you have a fever, cool compresses to the face can make you feel better, without dousing your internal high temperature which may be helping you fight off the infection. Having said all that, those prescribed low-dose aspirin for cardiovascular disease should continue to take it.

To bring this full circle, the ACE2 connection may also offer some insight into the inconsistent findings between current and past smokers. Nicotine may downregulate ACE2. So, while it’s always a good idea to quit smoking, this may explain why active smokers may or may not necessarily be at significantly higher risk of COVID-19 progression.

Reversing your type 2 diabetes may help, as those with diabetes may suffer a more severe course. The same was true for past deadly coronavirus outbreaks: SARS and MERS— the Middle East Respiratory Syndrome.

“[I]n this regard, the virus has relentlessly highlighted our global Achilles heel of metabolic dysfunction,” but also “points to a prime opportunity to fight back.”  “That fight, however, is not going to be won only with Clorox, Purell, masks, or anti-inflammatory drugs. The fight will only be won through a serious commitment to improving everyone’s foundational metabolic health, starting with the lowest hanging evidence-based fruit: dietary and lifestyle interventions.”  In other words, “[c]onsuming fresh, fiber-rich whole foods could serve to mitigate some of the overwhelming [pro-inflammatory] immune response which appears to be compounded in patients with COVID-19 who have diabetes and obesity, and must be a central focus included in any clinical recommendations made to patients or healthcare systems during this pandemic.”

Excess body fat alone seems to be a risk factor independent of diabetes. Those with severe obesity (weighing more than 215 pounds at the average American’s height of five foot six) have seven times the odds of ending up on a ventilator. But even just being overweight puts you at risk. Those with a body mass index (BMI) of 28 or more (about 175 pounds at the average height) appear to be at nearly six times the odds of suffering a severe COVID-19 course. So, BMI of 28 or more puts you at more than five times the risk, and the average BMI in the United States is over 29. So, we’re not talking about obese. Just being overweight (skinnier, in fact, than the average American) may put you at significantly higher risk. The excess risk from the excess body fat may arise from greater systemic inflammation, fat covering the heart itself, or the restriction of breathing caused by excessive fatty tissue in the upper body. Even without taking weight into account, though, sadly, most American adults over the age of 50 suffer from a “co-morbidity” that may put them at risk,e such as heart disease, lung disease, diabetes, high blood pressure, or cancer.

I know I have my infectious diseases hat on right now, rather than my lifestyle medicine hat, but I can’t allow it to pass without comment that the major comorbid conditions for COVID-19 severity and death—obesity, high blood pressure, type 2 diabetes, and heart disease— all can be controlled or even reversed with a healthy enough diet centered around whole plant foods. Thus, in terms of the impact of nutrition, now more than ever, wider access to healthy foods should be a top priority, and individuals should be mindful of healthy eating habits to reduce susceptibility to and long-term complications from COVID19.

Not all risk factors are modifiable though. Advanced age is also a key risk factor for COVID-19 progression and death. Although the disease has afflicted newborns only a few days old through seniors in their 90’s, most patients (around 90 percent in one large case series) are between 30 and 79. The severity of disease, however, disproportionately affects older individuals. In China, the average age of those requiring intensive care was 62, compared to the non-ICU cases, which had an average age of 46. In the United States, even those 65 and older without underlying conditions or other risk factors appear to be hospitalized or end up in the ICU at approximately three times the rate of those age 19 to 64.

Though the media has capitalized on stories of young, healthy individuals suffering severe or even fatal outcomes, people under 65 without known underlying, predisposing medical conditions may only account for about 1 percent of COVID-19 deaths.  South Korea has some of the best data because they did such widespread testing. As you can see, of confirmed cases, only about 1 in 1000 confirmed died in their thirties and forties. So, if you’re healthy in your 30s and 40s only about 1 in a 1000 of dying, but for those in their 50s that rises to closer to 1 in 200. Those in their 60s, about 1 in 50 die. Those in their 70s it’s closer to 1 in 14, and in their 80s nearly 1 in 5 lost their lives to COVID-19.

Though the relative lack of testing makes U.S. data less reliable, based on the first few thousands of American cases that just got reported, these age-related death risks are similar, as you can see. Note those are percentages. Lots more younger people are getting infected, so if you look at just the absolute numbers, you can see a big chunk of people are getting hospitalized and sent to the ICU in their 20s, 30s, 40s, and 50s. Lots of younger and middle-aged folks are suffering significant illness, but the vulnerability of our seniors to the pandemic was exemplified by ground zero of the first major U.S. outbreak, a nursing home in Washington State. Of the home’s 130 or so residents, 101 became infected, and a third lost their lives.

Please consider volunteering to help out on the site.

Motion graphics by AvoMedia

Image credit: H_Ko via Adobe Stock. Image has been modified.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The severity of COVID-19 varies widely based on pre-existing conditions. Those with high blood pressure are at twice the odds of suffering a severe course, and those with cardiovascular disease have three times the odds. What’s more, those with either condition are about four times more likely to end up in the ICU. Those with COPD—chronic obstructive pulmonary diseases, like emphysema—appear to be at the highest risk, with six times the odds of a severe course for COVID-19, and nearly eighteen times the odds of an admission to the intensive care unit.

We know that exposure to air pollution can increase susceptibility to respiratory viral infections, and that may be the case with COVID-19 as well, as higher pollutant levels appeared to be correlated with pandemic deaths. But just as air pollution may influence COVID-19, COVID-19 may be influencing air pollution. Check out this satellite data from NASA. This is nitrogen dioxide pollutant levels before the pandemic, then after lockdown. Here’s what ground zero, Wuhan province, looked like at around this time last time last year, and then post-pandemic. Ready for some irony? The decrease in air pollution following the quarantine is so great that the COVID-19 pandemic might paradoxically have decreased the total number of deaths by drastically decreasing the number of fatalities due to air pollution, averting as many as 30,000 deaths a month in China. In other words, the air quality in China was so bad that COVID-19 may have ended up saving lives—like 1,000 lives a day!

A history of smoking is a risk factor for disease progression, though, surprisingly, active smoking may or may not be. This seeming paradox may provide a clue as to why those with high blood pressure appear to be at higher risk.

It’s easy to imagine why those with heart disease are at higher risk of crashing from COVID-19. Even without direct heart damage, lung infections can put a tremendous strain on the heart. Up to nearly 30 percent of patients hospitalized for regular pneumonia develop cardiovascular complications. About one in 35 suffer cardiac arrest, and those who don’t are still at four times higher risk of a heart attack or stroke within the first 30 days after being released from the hospital. Okay, but why is just having high blood pressure a COVID-19 severity risk factor?

Under certain circumstances, those hospitalized for regular pneumonia with hypertension may do even better. Investigators speculated this may be due to the anti-inflammatory effects of a common class of high blood-pressure drugs called ACE inhibitors (like lisinopril, for which there are more than a hundred million prescriptions dispensed annually in the United States alone). Super common drugs. And, indeed, people on those drugs not only appear to be less likely to die of pneumonia, but they seem to be less likely to even get pneumonia in the first place. Ironically, this same reason why those with hypertension may be protected from regular pneumonia may also be the reason why those with hypertension are at greater risk from COVID-19.

ACE-inhibitor drugs may be anti-inflammatory, but they may also upregulate the expression of ACE2, which, as you may remember, is the enzyme the COVID-19 virus spike protein latches onto in our lungs to infect our cells and spread. So, perhaps the reason those with hypertension seem to be doing worse is that so many of them are on this class of drugs, which may be making them more susceptible to viral attack.

ACE2 expression is increased in some of these comorbid conditions, but the drug connection has yet to be verified.  So, more evidence is urgently needed to confirm the relation—if any—between these high blood-pressure drugs and COVID-19. In the meanwhile, here’s a flow chart that can help guide your doctor. Should we be holding all the ACEs? Well certainly, those on these drugs for heart failure or severe or uncontrolled hypertension should continue on these drugs. (When ICUs are overwhelmed is definitely not the time to have a stroke.) However, the majority of people taking these drugs do so for treating well-managed mild hypertension, and for these patients, physicians may want to consider temporarily discontinuing them for those at high risk of contracting COVID-19, until we know more. As always, you should never just change or stop taking medications on your own without guidance from your prescribing practitioner.

Those of you who follow me on social media know that early on I recommended that people consider not taking ibuprofen unnecessarily, as it is another drug thought to boost ACE2 expression. While the concern again remains theoretical, no drug is completely benign. (NSAID drugs like ibuprofen cause intestinal lining damage in as many as 80 percent of users, for example.) So, no drug should be taken unnecessarily. Furthermore, NSAID use (ibuprofen use) is strongly advised against in lower respiratory tract infections, as it has been associated with higher complication rates in both children and adults with pneumonia. In fact, fever may actually be beneficial in COVID-19, and probably shouldn’t be routinely treated by any means. If you have a fever, cool compresses to the face can make you feel better, without dousing your internal high temperature which may be helping you fight off the infection. Having said all that, those prescribed low-dose aspirin for cardiovascular disease should continue to take it.

To bring this full circle, the ACE2 connection may also offer some insight into the inconsistent findings between current and past smokers. Nicotine may downregulate ACE2. So, while it’s always a good idea to quit smoking, this may explain why active smokers may or may not necessarily be at significantly higher risk of COVID-19 progression.

Reversing your type 2 diabetes may help, as those with diabetes may suffer a more severe course. The same was true for past deadly coronavirus outbreaks: SARS and MERS— the Middle East Respiratory Syndrome.

“[I]n this regard, the virus has relentlessly highlighted our global Achilles heel of metabolic dysfunction,” but also “points to a prime opportunity to fight back.”  “That fight, however, is not going to be won only with Clorox, Purell, masks, or anti-inflammatory drugs. The fight will only be won through a serious commitment to improving everyone’s foundational metabolic health, starting with the lowest hanging evidence-based fruit: dietary and lifestyle interventions.”  In other words, “[c]onsuming fresh, fiber-rich whole foods could serve to mitigate some of the overwhelming [pro-inflammatory] immune response which appears to be compounded in patients with COVID-19 who have diabetes and obesity, and must be a central focus included in any clinical recommendations made to patients or healthcare systems during this pandemic.”

Excess body fat alone seems to be a risk factor independent of diabetes. Those with severe obesity (weighing more than 215 pounds at the average American’s height of five foot six) have seven times the odds of ending up on a ventilator. But even just being overweight puts you at risk. Those with a body mass index (BMI) of 28 or more (about 175 pounds at the average height) appear to be at nearly six times the odds of suffering a severe COVID-19 course. So, BMI of 28 or more puts you at more than five times the risk, and the average BMI in the United States is over 29. So, we’re not talking about obese. Just being overweight (skinnier, in fact, than the average American) may put you at significantly higher risk. The excess risk from the excess body fat may arise from greater systemic inflammation, fat covering the heart itself, or the restriction of breathing caused by excessive fatty tissue in the upper body. Even without taking weight into account, though, sadly, most American adults over the age of 50 suffer from a “co-morbidity” that may put them at risk,e such as heart disease, lung disease, diabetes, high blood pressure, or cancer.

I know I have my infectious diseases hat on right now, rather than my lifestyle medicine hat, but I can’t allow it to pass without comment that the major comorbid conditions for COVID-19 severity and death—obesity, high blood pressure, type 2 diabetes, and heart disease— all can be controlled or even reversed with a healthy enough diet centered around whole plant foods. Thus, in terms of the impact of nutrition, now more than ever, wider access to healthy foods should be a top priority, and individuals should be mindful of healthy eating habits to reduce susceptibility to and long-term complications from COVID19.

Not all risk factors are modifiable though. Advanced age is also a key risk factor for COVID-19 progression and death. Although the disease has afflicted newborns only a few days old through seniors in their 90’s, most patients (around 90 percent in one large case series) are between 30 and 79. The severity of disease, however, disproportionately affects older individuals. In China, the average age of those requiring intensive care was 62, compared to the non-ICU cases, which had an average age of 46. In the United States, even those 65 and older without underlying conditions or other risk factors appear to be hospitalized or end up in the ICU at approximately three times the rate of those age 19 to 64.

Though the media has capitalized on stories of young, healthy individuals suffering severe or even fatal outcomes, people under 65 without known underlying, predisposing medical conditions may only account for about 1 percent of COVID-19 deaths.  South Korea has some of the best data because they did such widespread testing. As you can see, of confirmed cases, only about 1 in 1000 confirmed died in their thirties and forties. So, if you’re healthy in your 30s and 40s only about 1 in a 1000 of dying, but for those in their 50s that rises to closer to 1 in 200. Those in their 60s, about 1 in 50 die. Those in their 70s it’s closer to 1 in 14, and in their 80s nearly 1 in 5 lost their lives to COVID-19.

Though the relative lack of testing makes U.S. data less reliable, based on the first few thousands of American cases that just got reported, these age-related death risks are similar, as you can see. Note those are percentages. Lots more younger people are getting infected, so if you look at just the absolute numbers, you can see a big chunk of people are getting hospitalized and sent to the ICU in their 20s, 30s, 40s, and 50s. Lots of younger and middle-aged folks are suffering significant illness, but the vulnerability of our seniors to the pandemic was exemplified by ground zero of the first major U.S. outbreak, a nursing home in Washington State. Of the home’s 130 or so residents, 101 became infected, and a third lost their lives.

Please consider volunteering to help out on the site.

Motion graphics by AvoMedia

Image credit: H_Ko via Adobe Stock. Image has been modified.

100 responses to “Modifiable Risk Factors and Comorbidities for Severe COVID-19 Infection

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  1. There has been a lot of talk here regarding how “nobody is talking about” how this disease, so frighteningly aggressive, has affected people who have survived Covid 19, apparently not old (sorry, above 60 is old in this context), and having been, I suppose, ripped from their previous state of perfect health, body-weight, and dietary lifestyle, into a life of wheelchairs and oxygen masks.

    The message has seemed to be that these folks were not headed there at some point in the near future and their lives are now ruined – not by their own comorbidities, but by Covid. This breeds fear since one could imagine randomly getting this thing and then, even if you survive, you are fu@ked.

    Will Dr, Greger be addressing this?

    Is it not what his findings are, since he and his team are obviously pouring over tons of data, and studies currently exploding onto the research landscape?

      1. Would note a word of caution that the trouble with baking soda, sodium bicarbonate, is that too much sodium will raise blood pressure and hurt your endothelium lining of your arteries, potentially making you MORE susceptible to a harsh form of COVID-19 as the endothelium is a huge sink of ACE-II receptors which is what mediates SARS-COV2 virus to bring it inside the cells where it replicates. Alkalizing your body is as simple as following a plant based diet. Haven’t seen the literature on its correlation to fighting viruses, however, there is an abundance of literature supporting animal free, SOS free, fiber rich whole-food plant based diets boosting immunity. As is typical, avoid the quick miracle cure, opt instead for the scientifically proven healthiest diet to avoid disease.

        https://nutritionfacts.org/video/sodium-and-arterial-function-a-salting-our-endothelium/

        https://nutritionfacts.org/video/lowering-our-sodium-to-potassium-ratio-to-reduce-stroke-risk/

      2. If you somehow figure out how to alkalize your body, you will die. Our bodies maintain a very narrow range of pH all on their own. People get confused by eating alkaline or acidic foods, which is not the same as alkalizing your body.

      3. Your skin loses its ability to fend off any pathogen when it gets alkaline. The surface needs to be slightly acid. Soap is alkaline, so it dries out your skin, making you susceptible to all kinds of skin problems. Baking soda has the same effect, more or less. The more often you use either one, the more problems you can get.

    1. To make matters worse jazzbass, the way I see it, we’ll be handed the ‘bill’ in the next year or two for the extraordinary expenses we have incurred during the pandemic season (though I can’t really envision it going away …) and since the coffers will be bare, those people needing long term or life-long therapy /rehab may be out of luck.

      1. The coffers were already bare, we’re just printing money (actually mostly just adjusting electrons in a computer system).

        The real problem for people needing long-term care from COVID or ANYthing else is that the health care system is being bankrupted by lack of business. The hospitals having issues and closing are also in poor, rural areas. Which is not a surprise, the poor are always screwed first, last and hardest.

    1. Deb,

      Why? What does the science say?

      “They” are using all kinds of devices and supplements, and trying all kinds of “treatments.” There is a lot of quackery out there.

        1. Deb,

          I did not find any evidence that the FDA cleared the use of these devices in the ICU to help deal with inflammation.

          What I did fin, from the press release you linked above, was that the company “will donate SofPulse devices to intensive care units and medical professionals for investigational use to evaluate SofPulse PEMF technology’s inflammation reduction effect to determine potential efficacy in reducing symptoms of respiratory inflammation and distress in COVID-19 patients.” This is reportedly for investigative purposes only; I didn’t read that any hospitals have accepted this offer, much less what the results are. Or that the FDA has cleared the device for this purpose.

          The FDA has authorized this device to be marketed as substantially equivalent to legally marked predicate devices (meaning, it’s not new, and no substantive review was done). The stated use is adjunctive use in palliative care in post-operative pain and edema in superficial soft tissue. https://www.accessdata.fda.gov/cdrh_docs/pdf7/K070541.pdf

          If you have any evidence supporting your statement that the FDA has cleared use of these devices in the ICU, I would be interested in seeing it.

  2. Another risk factor for Covid-19 is income, along with race (at least in older folks, since this data was based on Medicare billing records):

    “Income is a potent force along with race in determining who among the nation’s vulnerable, older population has been infected with the novel coronavirus, according to a federal analysis that lays bare stark disparities in the pandemic’s toll…. they also point to the role of poverty as the pandemic has sped through U.S. communities in the winter and spring…. For men, women and every racial, ethnic and age group of Medicare beneficiaries, the rate of coronavirus cases among those with incomes low enough to be on Medicaid is far higher than for everyone else in the analysis.”
    https://www.washingtonpost.com/health/income-emerges-as-a-major-predictor-of-coronavirus-infections-along-with-race/2020/06/22/9276f31e-b4a3-11ea-a510-55bf26485c93_story.html?fbclid=IwAR3PfEk7HDpfLAURsT6G3b_-bSasQ4Kqd2DuPAWk20NkU7OnTv7x1uwjUOE

    I think that there is an interplay between poverty and underlying co-morbidities, as well as in the difficulty accessing decent health care, and the inability to work from home, and to effectively socially distance, and the need to use public transportation. We have huge socioeconomic disparities in this country, that make folks in the lower levels so much more susceptible to this dreadful disease.

    1. Dr J, regarding your comment: “We have huge socioeconomic disparities in this country … “,

      We should pass a law that all politicians have to donate to charity three things: their salary, campaign money, and any graft they receive through “Foundations”.

      I’ll bet that would solve any disparity overnight ;-)

    2. Dr. J.,

      Vox has a video on how air pollution. It is about how housing discrimination has caused black people to live near chemical plants. Blacks are not the only poor people who have been forced to live near the biggest environmental hazards.

      https://www.youtube.com/watch?v=XAFD-0aMkwE

      That one is more specifically toward the black community but the Latino community and poor white community have housing situations, too.

      Those are other videos online.

      Being forced to live in air pollution without broccoli sprouts should be illegal.

        1. Neither is safe drinking water or sanitation.

          More than 2 million people in the U.S. lack running water and basic indoor plumbing

          https://www.marketwatch.com/story/2-million-americans-dont-have-access-to-running-water-and-basic-plumbing-2019-11-20#:~:text=More%20than%202%20million%20people,to%20clean%20water%20and%20sanitation.

          About 23.5 million people live in food deserts. Nearly half of them are also low-income. Approximately 2.3 million people live in low-income, rural areas that are more than 10 miles from a supermarket.

          https://www.dosomething.org/us/facts/11-facts-about-food-deserts#:~:text=About%2023.5%20million%20people%20live,10%20miles%20from%20a%20supermarket.

          1. 6 million people have zero dollars income in America.
            20.5 million are raising 3 family households on less than $9000
            A quarter of the jobs in America pay less than the poverty level
            A half of the jobs in America pay less than $33,000

            Welfare assistance or Temporary Assistance for Needy Families only goes to about 2.7% of the children who are in poverty.

            I never know whether people know that type of thing.

      1. Deb, Regarding your comment: “Being forced to live in air pollution without broccoli sprouts should be illegal.”

        You could start a new movement with that one! As if we don’t have enough movements going on already :-(

        1. Laughing.

          The fact that it could save lives by protecting people from the effects of air pollution would make it a pretty good movement.

          I ended up looking up rent costs in America – knowing that half of Americans live under $33,000 a year. Where I am, even welfare motels cost about $1000 per month. The lowest-priced rents around the country are close to $600. So $7200 in rent for people making $9000 per year is pretty tight. I do know people who fell into that condition.

          Elderly people, a lot of seniors who are older have much lower social security levels. They lose their houses even if they had already paid for them. My grandmother was earning $8000 per year, but that is higher than a lot of people. Not high enough to pay for much more than taxes and utilities.

          1. Deb, Actually, I do eat some broccoli sprouts almost every day and the air pollution in my area is not that bad. Once catalytic converters were put on cars, most don’t pollute much anymore at all

            And compared to most countries in the world, the US has very good air quality. China probably has the worst now.

            1. Thank goodness for centralized government regulating in such a way as to care for all its citizens, even if its rare, and despite individual states containing stupid people who would fight seat-belts requirements on principle of solidarity.

              China ironically is at the forefront of environmental progressive change. We wont hear that anywhere in the US, but the information can be found by looking into it.

      2. (More posted on Vitamin D deficiency and Covid-19 vuknerability in other posts below)

        Epidemiological studies in fact show widespread Vitamin D deficiency:

        http://ajcn.nutrition.org/content/87/4/1080S.abstract
        Vitamin D deficiency: a worldwide problem with health consequences1,2,3,4
        Vitamin D deficiency is now recognized as a pandemic. The major cause of vitamin D deficiency is the lack of appreciation that sun exposure in moderation is the major source of vitamin D for most humans. Very few foods naturally contain vitamin D, and foods that are fortified with vitamin D are often inadequate to satisfy either a child’s or an adult’s vitamin D requirement.

        And this problem becomes much worse during the winter, as well as yearround for certain populations, such as the elderly, or for blacks. And as I mentioned above, Black Americans – who reportedly have the highest CV-19 death rates ALSO have a much higher rate of Vitamin D deficiency than average:

        https://academic.oup.com/jn/article/136/4/1126/4664238 Vitamin D and African Americans Susan S. Harris The Journal of Nutrition, Volume 136, Issue 4, April 2006, Pages 1126–1129,
        “Vitamin D insufficiency is more prevalent among African Americans (blacks) than other Americans and, in North America, most young, healthy blacks do not achieve optimal 25-hydroxyvitamin D [25(OH)D] concentrations at any time of year. This is primarily due to the fact that pigmentation reduces vitamin D production in the skin. . . . Clinicians and educators should be encouraged to promote improved vitamin D status among blacks (and others) because of the low risk and low cost of vitamin D supplementation and its potentially broad health benefits.”

        As far as Covid-19 goes, I find this report from Psychology Today a reasonably credible report:

        https://www.psychologytoday.com/us/blog/social-instincts/202005/research-suggests-link-between-vitamin-d-deficiency-and-covid-19-deaths

        “Key findings:
        • “A majority of COVID-19 cases with vitamin D deficiencies died.
        • The odds of death were higher in older and male cases with preexisting conditions and lower than normal Vitamin D levels.
        • When accounting for the effects of age, sex, and comorbidity, vitamin D status is strongly related to COVID-19 mortality.

        This research adds to a growing body of scientific literature linking vitamin D to COVID-19 severity. A recent report released by Mark Alipio of Davao Doctors College in the Philippines found that normal vitamin D levels were more likely to be observed in patients with mild cases of COVID-19. To be specific, he estimated that normal vitamin D levels increase the odds of having a mild clinical outcome by approximately 19.6 times.”

    3. Dr. J, If a person with covid19 is on medicaid, [in most states] the hospital is automatically $12,000 to admit them. If they are put on a ventilator, the hospital gets about twice that much. Can you see why these diagnosis of these people would be much higher? In the area where I live, every death certificate of someone on medicaid HAS to have the cause of death listed as C19, no exceptions allowed. They even admit dead people who drowned or died in a car accident, make sure the “cause of death is” C19. You cannot believe the numbers reported are even remotely accurate.

  3. I noticed that Dr Greger kept saying Type 2 diabetes as a risk. I’m a Type 1 diabetic who eats a WFPB diet and keeps her blood sugar under tight control. When it comes to diabetes being a risk for Covid 19, is it all diabetics or diabetics who aren’t in control of their blood sugar and have other issues?

    1. That is a good question. My husband is a type 1 too. He has been eating whole food plants only and has got many good results. I would say that he has been doing much much better than most other SAD eating type 1s. But he still needs to be more careful than a healthy someone else who has no chronic diseases.

      1. Yaffa and Grace,

        Dr. Barnard has covered this issue but it might be hard to find his video because they put one out just about every day.

        I do know that, of the people with diabetes who had COVID-19 serious enough to hospitalized in China, they said that 58% of them had high blood sugar versus normal blood sugar.

        I wish I could find his video for you because he showed that high blood sugar raised the risk of mortality considerably. The ones who had their blood sugar under control were much less likely to die.

        1. Deb, thanks for your response! I think you are right. I just feel that it is likely harder for a Type 1 diabetic to recover than a healthy person once being infected. So that is why type 1s need to be more careful.

          == Yaffa and Grace,

          Dr. Barnard has covered this issue but it might be hard to find his video because they put one out just about every day.

          I do know that, of the people with diabetes who had COVID-19 serious enough to hospitalized in China, they said that 58% of them had high blood sugar versus normal blood sugar.

          I wish I could find his video for you because he showed that high blood sugar raised the risk of mortality considerably. The ones who had their blood sugar under control were much less likely to die.

    1. ill read it but you must know that NYT, WAPO, LAT, are just not trustable…Of course there can be some fact mixed in so I will read…

      1. oh yes…Scratch that. Just tried…Its a paywall site. Screw them, not going there…(imagine paying to read text from an entity that clearly carries water for the security state?)

      2. jazzBass, you like many are able to hear issues from both sides of the aisle and then can weigh them and form your own opinion. Sadly, there are many more who go to NYT/WAPO/LAT/NPR exclusively and do not realize that there is another viewpoint to consider. I was in that group at one point in my life, not so long ago, but no more. Hopefully more people will eventually wake up…. Setting out both sides of an issue is what journalism provided to us years ago.

        1. Thanks, and it seems like maybe not so many understand this as you say- but I like your optimism. Perhaps many more than two sides to any given issue too… :)

          The absolute most important thing is not to compartmentalize. Its a disease far greater than Covid. The disease of compartmentalization.

          …Like going to church on Sunday, then going to congress Monday, and voting to send billions of dollars to Israel, while at their hands the occupied oppressed Palestinians perish in open air prisons, with water, electricity, medical, food, travel, construction materials, technology, being restricted controlled or denied, and their land getting illegally annexed into untenable isolated bantustans.

          Meanwhile we can talk about a friend in Israel who went to the beach but had to have a note they carry with them as an inconvenience of Covid.

          Its compartmentalization that is the real problem in the world.

          As soon as we actually and once and for all, study and experience the graciousness, the similarities of having and wanting to help a child,a mother, a father, a brother (how others don’t enjoy their own suffering OR the suffering of others), and too, learn the struggles of other peoples, feel connected with them all with no feelings of superiority, and understand why they do what they do under forces of sanctions or political plays which we know about because we take the trouble to look beyond CNN, only then, will we rid ourselves of this disease.

          It may be why I don’t care much about covid. Its such an inconvenient temporary blip to read about in our future, and all the other problems remain and get worse with nobody giving a rats ass.

  4. Dr. Greger spoke about the high mortality rate of seniors even if they do not have comorbidities. Am I, a healthy 74 year old a sitting duck for Covid-19?

    1. Arun Mukherjee,

      I think that increasing age itself is a risk factor for acquiring a serious case of Covid-19; the older a person is, the higher the risk. But, we don’t know what “healthy” or no co-morbidities actually means. For example: What did these patients eat? Did they exercise, and if so, how much? Etc.

      Moreover, even if the fatality rate is high, I look at it the other way: The survival rate is even higher, at least 80% and maybe even 90% in the most at-risk population. I know of a friend of a friend, an older gentleman in his 90s, who was tested as positive for having antibodies for the coronavirus, and he doesn’t even remember being very sick — it never occurred to him that he had Covid-19. (He has cancer, which is why he was tested.)

      So my opinion is that you are not a “sitting duck for Covid-19.” That said, I am continuing to take precautions (I’m 69, my husband is 77): sheltering at home, leaving infrequently for errands, while wearing a mask; washing my hands often, avoiding social interactions in person. And, of course, continuing to eat a whole plant foods diet, exercising, not smoking, drinking alcohol moderately if at all, getting plenty of sleep, etc.

      1. I agree with your plan Dr J, and though others in my area do not take it so seriously, I am doing the same as you. I am prepared to keep living this way a long time. No eating out or social occasions, minimal grocery shopping, (no shopping online either), but lots of
        exercise, sun, and good food, along with endless cleaning and handwashing.

        1. Barb,

          Now this “cleaning” you mention is a fascinating concept…especially “endless cleaning”…

          I’d rather be outside, playing in the dirt (aka doing yard work and gardening) or walking or bicycling, or inside, reading a good book or magazine. I gave up on most cleaning a while ago.

          Which reminds me of a book I read when I met my first husband, who was considerably older than I was: “Oh, To Be 50 Again.” One idea especially resonated: that old people do less house cleaning not because they lack the energy, but because they realize that time is limited, and they’d rather spend it doing something more enjoyable. And I thought: “Wow!! I’m already an old person!!” (In my late 30s.)

          1. Dr J, not everyone enjoys an optimal environment where they can pleasantly while away the hours. If you saw where I lived, you might appreciate the courage it takes to even go outside to get exercise on a regular basis, and the determination it takes to ‘keep cleaning’.

            1. Barb,

              You are correct; I stand corrected. I am very fortunate as to where I live. And for much more.

              But I still hate housework. I have done it in the past to earn a living, and for some reason, ever since then, I have liked doing it less and less.

      2. Dr. J,

        Thank you. Like you, I am mostly sheltering at home, going to the grocery store or drug store as little as possible. I have not taken public transit since mid March and do not have a car. So, it is a bit of a challenge.

    2. Yes unless you counter it with proper nutrition. And you must be exposed to the extent that it would grab a good hold. So sitting duck, yes. Flying duck no.

    3. Arun, this study came out a week ago. You can test endothelial function with the ADMA/SDMA blood test at Quest Diagnostics. You can test for atherosclerosis with a coronary calcium scan (which your insurance will not cover) or carotid artery ultrasound (which insurance might cover).

      “Covid-19 accelerates endothelial dysfunction and nitric oxide deficiency” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229726/ “SARS-CoV-2 is emerging as a thrombotic and vascular disease targeting endothelial cells throughout the body and is particularly evident in patients with cardiometabolic comorbidities, in particular hypertension, with associated endothelial dysfunction. A hallmark of endothelial dysfunction and thrombotic events is suppressed endothelial nitric oxide synthase (eNOS) with concomitant nitric oxide deficiency….Restoring nitric oxide, independent of eNOS, may counter endotheliitis and contribute to pulmonary vasodilation, antithrombotic, and direct antiviral activity…Alternatively, dietary inorganic nitrate has been shown in multiple studies to be effective at restoring endothelial function, reducing pulmonary and arterial hypertension, and promoting antimicrobial activity. It is well understood that dietary inorganic nitrate is bio-converted to nitric oxide through a series of well-defined steps beginning with the friendly microflora on the tongue reducing nitrate to nitrite, which is subsequently reduced to nitric oxide in the gut, blood stream, and various organs, including the lung. The formation of inorganic nitrite and S-nitrosothiols is absorbed into the circulation where it acts as a transitory storage pool for subsequent nitric oxide production…Restoring nitric oxide through dietary inorganic nitrate may be a consideration for prevention and early treatment which would operate at two-levels: reverse platelet-endothelial dysfunction and associated thrombosis as well as lower viral burden.”

      Other tips for improving endothelial function (in addition to increasing dietary nitrates) include eliminating mouth breathing, eliminating mouthwash, and chewing your nitrate-rich foods very well.  The diet to follow is an Ornish/Esselstyn low fat, high fiber, low salt vegan diet. Dr. Greger’s videos address certain foods that may help or harm endothelial health. If your ADMA/SDMA blood test and your weight are in the normal range, you have no comorbidities,  you exercise regularly, and you follow the suggested diet, I would imagine that your risk of severe illness from COVID-19 due solely to age is not as high as many articles would lead you to believe. But I am not a medical professional; perhaps Dr. Greger can weigh in

      1. Caroline, thank you so much for sharing this information. I am familiar with Dr. Esselstyn’s work on nitric oxide and follow his advice to eat a lot of greens. It is reassuring that these food choices would help with the severity of COVID.

    4. Arun Mukherjee,

      Keep keeping up on it.

      In Italy, right now, people who are in their 90’s have started living through it and the newer cases have a smaller viral load. They said that age groups that used to die within a few days are now living through it and there are fewer people on ventilators.

      That being said, there are doctors who argue against that concept and it seems like different places have different versions of COVID-19 – though that is ALSO debated hotly online.

      So, I guess, don’t be a sitting duck, keep your ducks in a row. Get outside and get Vitamin D and be careful in places with air conditioning.

      Do the basics well.

      Wear a mask if you can, stand 6 feet away, wash your hands and don’t touch your face and take advantage of being able to go outside if you want to see people that is where to do it.

      The protests didn’t cause all that much of a spike is what some areas are saying – though I tend to question authority and there are spikes in over 20 states and it may be that the protests might have increased the spikes in some places but some places they looked for spikes didn’t get them.

      But know where you live and what the transmission rate is.

      If you live someplace where the hospital beds are pretty full right now, don’t take risks.

      1. Deb, good to know that the mortality among the older Italians has declined somewhat. And yes, to keep my ducks in a row is very important. One can’t let one’s guard down with hand washing, social distancing and wearing a mask. I am not rushing out to get my nails or hair done!

  5. One possibility not mentioned with obese or overweight individuals having more severe symptoms is low vitamin D levels. Given D is fat soluble, I have read that obese individuals may want to take 2 to 3 times the normal recommended amounts to compensate.

    1. Sally,

      Yes, obese people have a much harder time getting their Vitamin D from the sun.

      Ignore jazzBass’s sarcastic comment.

      jazzBass, COVID-19 is a right now type of thing. People who are obese can possibly lose weight but that is then and this is now.

  6. ALL,

    Methyl or Cyano for B-12? Dr. Gregor giving a webinar on it the 26th…any ideas what he will say?

    Im doing methyl now its “vegan”, all I could find in a spray. Heard we dont get much form the pill form…

    1. jazzBass, you can get a DNA test with one of the big three genealogy/DNA sites, download your raw data, and upload it to promethease.com. For $12 Promethease will analyze the health implications of your DNA. I found from the analysis that I have a problem absorbing nutrients not in methyl form, both B12 and folate. They provided all sorts of other information about my genetic predispositions along with the caveat that these gene variants usually are a smaller factor than environment and lifestyle in determining whether you actually develop the disease. This is such good information to have and at a rock bottom price compared to what one would have paid just a few years back. If you are price sensitive, wait for a sale, since all three genealogy/DNA sites have sale prices regularly. MyHeritage is a cheek swab, while 23andme and Ancestry have you spit into a vial.

      1. Caroline, wow! Id thought this was purely for understanding where we came from, and genealogical associations.

        Admittedly handing over our personal operating system code to an entity whom we have no way of knowing who its shared with, or what could be done with it at some future point, is less than attractive.

        As I’m first generation here, Ive felt this would bring me limited info. I dont know how many other countries populations participate in this sort of thing.

        1. Just looked into it, and Prometheus info is gained through my sharing info from the big 3. I know you are already aware of this. I saw in terms and conditions that the info is not shared and I own it.

          …Except for 3rd party permissions, one of which is Amazon storage. I do not know that if by using Amazon as a customer to buy light bulbs, I’ve inadvertently given permission to them to store/use/share my data for any purpose they deem, or even a few selected purposes, without pouring over that original agreement, which I have no copy of, of course..

        2. Europe has very good records, Asia and south of the border not so much. MyHeritage will start a family tree for you based on your DNA relatives who have participated. I was able to help a lady in Great Britain who according to MyHeritage was related to me and others in my family tree. She apparently had either an adoption or an out of wedlock situation in her family tree, and had no idea that she was related to me. I shared medical information with her and suggested that she pay for the Promethease analysis to see whether some of the gene variants were passed on to her.

          Some people are concerned that the information could fall into the wrong hands (the military or insurance companies) but remember the caveat that environment and lifestyle are extremely important factors in determining whether or not you develop a condition for which you have a genetic predisposition. The concern with the military is that some people hide a disqualifying medical condition and if the military were to find out, their military career is over.

          1. Correction, it is 23andme (not MyHeritage) that provides a beta DNA family tree. It shows only the living people though, and you have to figure out the prior generations. If you are a recent immigrant from a country without good ancestry records, this feature might not be helpful.

    1. Lives saved.
      How about in the US? I wonder if Asthma hotspots in the US have found respite from the aggressive onslaught of our gas guzzlin’ 4-whellin SUV’s we buy, just in case it snows. (Then we stay home and take a snow day, instead, firing up our gas driven snowblowers)

  7. As far as modifiable risk factors go, it looks like Dr. Greger missed an REALLY important one – Vitamin D deficiency. Given the high % of those with Vitamin D deficiencies in the U.S. and how this % goes up even higher in the winter, and its association with vulnerability to the flu and flu severity, one inexpensive possible solution to mitigating both seasonal flu and Covid-19 seems obvious – that those in locations where they can not get enough sun should supplement with Vitamin D – for most people 2,000 IU or so a day should do it. This did not seem rocket science.

    One of the studies just released in the past few months (from Louisiana State University Health Sciences Center dated April 24th) examined Vitamin D insufficiency (VDI) in severe COVID-19 patients reported that “Among ICU subjects, 11 (84.6%) had VDI, vs. 4 (57.1%) of floor subjects. Strikingly, 100% of ICU patients less than 75 years old had VDI.”

    In another recently release report researchers “estimated that normal vitamin D levels increase the odds of having a mild clinical outcome by approximately 19.6 times.”

    On the Vitamin D front, on May 11th in Medscape, rather belatedly one expert” at Harvard came around and stated the obvious:

    https://www.medscape.com/viewarticle/930152

    Does Vitamin D Protect Against COVID-19?

    “Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital.
    I’d like to talk with you about vitamin D and COVID-19. Is there potentially a protective role? ( . . . )
    So the evidence is becoming quite compelling. It’s important that we encourage our patients to be outdoors and physically active, while maintaining social distancing. This will lead to increased synthesis of vitamin D in the skin, just from the incidental sun exposure. . . . For patients who are unable to be outdoors and also have low dietary intake of vitamin D, it’s quite reasonable to consider a vitamin D supplement. The recommended dietary allowance of vitamin D is 600-800 IU/daily, but during this period, a multivitamin or supplement containing 1000-2000 IU/daily of vitamin D would be reasonable.”

    And yet our government has STILL not recommended Vitamin D supplementation even to those groups that have the highest levels of Vitamin D deficiency, who also have, not at all coincidentally ,the highest rates of death from Covid-19 – the black community and the elderly.

    Good grief.

    1. Alef1

      The problem is that ‘the role of vitamin D supplementation in COVID-19 patients, to enhance disease resistance or as adjuvant therapy, awaits results of well-designed experimental studies.’
      https://www.metabolismjournal.com/article/S0026-0495(20)30140-2/pdf

      Authorities and individuals committed to evidence-based medicine do not usually recommend unproven therapies. There is for one thing always the possibility that association studies confuse cause and effect. For example, do morbidities like obesity, cardiovascular disease, hyperthyroidism. cancer, respiratory diseases, kidney diseases etc cause vitamin D levels to decline? Sicker people are also more likely to be housebound and obtain less sunlight, and therefore have lower vitamin D levels.

      That said, I agree that vitamin D supplementation is a prudent precaution. Especially in older people since conversion from sunlight becomes less efficient with ageing as does kidney production of vitamin D. It’s also cheap and safe The US tolerable upper limit for daily vitamin D intake (from all sources) of 4.000 mcg per day.
      https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

      1. “The problem is that ‘the role of vitamin D supplementation in COVID-19 patients, to enhance disease resistance or as adjuvant therapy, awaits results of well-designed experimental studies.’

        “Authorities and individuals committed to evidence-based medicine do not usually recommend unproven therapies.”

        I understand this point of view.

        Of course, correlation does not prove causation. However, one needs to take into account but a pandemic does not seem an “as usual condition.” I note that doctors, hospitals and governments during this pandemic have had no problem endorsing, and inflicting on patients a number of expensive and potentially quite harmful and expensive therapies based on a far poorer rationale and evidence base than Vitamin D. Chloroquine comes to mind, with 50 250 mg tablets oral tablet 250 mg costing around $331.

        So when does it become prudent to recommend “unproven therapies”, such as for example lifestyle medicine when one often only has evidence of correlation but not yet causation? I’d say when one can successfully apply the “do no harm rule,” by looking at the potential benefit, AND at the potential harm, the probability that a therapy might cause harm, and not just physically but financially. Chloroquine fails both these tests. Vitamin D does not, which seems a big part of the problem – no one makes money from recommending Vitamin D, certainly not the pharmaceutical industry,

        And the solid evidence for Vitamin D insufficiency playing a significant role with respect to the flu does exist. See for example:

        From BMJ. 2017 Feb 15;356. doi: 10.1136/bmj.i6583: https://www.ncbi.nlm.nih.gov/pubmed/28202713

        “Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data.”

        ” Conclusions Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.”

        And as far as the seasonal flu goes, this:

        http://www.nber.org/papers/w24340

        ABSTRACT
        Recent medical literature suggests that vitamin D supplementation protects against acute respiratory tract infection. Humans exposed to sunlight produce vitamin D directly. This paper investigates how differences in sunlight, as measured over several years across states and during the same calendar month, affect influenza incidence. We find that sunlight strongly protects against influenza. This relationship is driven by sunlight in late summer and early fall, when there are sufficient quantities of both sunlight and influenza activity. A 10% increase in relative sunlight decreases the influenza index in September or October by 0.8 points on a 10-point scale.

        A second, complementary study employs a separate data set to study flu incidence in New York State counties. The results are strongly in accord. Remarkably, the national results are driven almost entirely by the severe H1N1 epidemic in fall 2009. That year the flu epidemic was intense, and it began early, so that September-October sunlight could play a major protective role. We also compare sunlight protection to protection produced by vitamin D supplementation in randomized trials. The sunlight effect was far greater. A plausible explanation is that exposure to sunlight is far broader, and sufficient to provide herd immunity.

        http://ajcn.nutrition.org/content/87/4/1080S.abstract
        Vitamin D deficiency: a worldwide problem with health consequences1,2,3,4
        Vitamin D deficiency is now recognized as a pandemic. The major cause of vitamin D deficiency is the lack of appreciation that sun exposure in moderation is the major source of vitamin D for most humans. Very few foods naturally contain vitamin D, and foods that are fortified with vitamin D are often inadequate to satisfy either a child’s or an adult’s vitamin D requirement. Vitamin D deficiency causes rickets in children and will precipitate and exacerbate osteopenia, osteoporosis, and fractures in adults. Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases. A circulating level of 25-hydroxyvitamin D of >75 nmol/L, or 30 ng/mL, is required to maximize vitamin D’s beneficial effects for health. In the absence of adequate sun exposure, at least 800–1000 IU vitamin D3/d may be needed to achieve this in children and adults. Vitamin D2 may be equally effective for maintaining circulating concentrations of 25-hydroxyvitamin D when given in physiologic concentrations.

        And with respect to its potential impact on Covid-19, a repeat from recent article in Medscape:

        “Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital. I’d like to talk with you about vitamin D and COVID-19. Is there potentially a protective role? ( . . . )
        So the evidence is becoming quite compelling.”

        My “good grief” comment stands.

        And now for Covid-19 to me seems compelling.

      2. Mr. Fumblefingers, re: “There is for one thing always the possibility that association studies confuse cause and effect. For example, do morbidities like obesity, cardiovascular disease, hyperthyroidism. cancer, respiratory diseases, kidney diseases etc cause vitamin D levels to decline?”. That is true, and only placebo controlled studies can truly answer that. However, with vitamin D ( same could be said for C ), virtually no one (very rare exceptions) who does not either supplement or get plenty of sunshine, have vitamin D levels at or above 30 ng/ml. For example, after I had been supplementing with 2000 IU/day for some months, I was disappointed to learn that my blood level was only 30. Which must have meant that most of my life I was quite deficient. 10,000 a day got me up to 80, so I settled on a level closer to 5000. …………….. So, in most of these studies, if a person has a baseline level of 30 or higher, it almost certainly means they have been supplementing. ( we must also consider that so many people supplement these days, so whatever level that they do have has been boosted by that fact) Therefore, it is highly unlikely that all of those folks who have done very poorly with CV-19 had their levels lowered by the disease. It is very likely that the majority of them had a low vitamin D level way before they ever came down with CV-19.

        Conversely, all those folks who have mild cases of CV-19 and also just happen to have levels of 30 or above, I’m sure it is obvious to all of us that the disease did not cause their high levels, rather supplementation (or sun bathing) caused their high levels. And it just so happens that most folks with the higher levels are the same ones who are having a much easier time with the CV-19. So, it is quite likely- but not PROVEN yet – that supplementing with D or sunbathing has helped them survive the virus, in almost all cases those with high levels not needing ICU or ventilators. I’m pretty sure that thousands have died for lack of information on this from our government/medical leaders.

        The same can be said for vitamin C blood levels vs supplementation or IV infusion once at the hospital. I had- before the studies on D started coming in- been offering to bet that every person in ICU with CV-19 had low D AND C. With the C being almost zero. That is because C is not only at a barely health maintenance level in most of our populations ( especially compared to most animals who make their own at thousands mg mg per day ), but whatever C we do have is rapidly used up to fight various disease processes. So I’m willing to bet that- unless they took a bunch right before they got admitted to ICU when they realized how sick they were- that almost every one in ICU with CV-19 is not only very low in D, but almost zero blood levels of C. They have been making the measurements for D, God bless them, but now they need to do so for C. Some critical care docs, such as Paul Marik and others, have been having spectacular success with iV vitamin C along with cheap, off patent, methylprednisolone. But if they used even higher doses of the vitamin C, they might not even need the drug. But either way, IV vitamin C is a huge help. https://covid19criticalcare.com/treatment-protocol/

    2. But they fortify milk by the trillions of gallons, with vitamin D……Don’t they? Why do they put vitamin D in if we are not requesting the public get more Vitamin D?

      I’m confused by this suggesting of missing an important factor.

      Did Dr G miss it? Perhaps he saw it, but knows its not a verifiable or even co-causal component given the amount of milk, yogurt, butter and cheese the world consumes.

    3. Hi jazzBath.

      No, looks like he missed it.

      Epidemiological studies in fact show widespread Vitamin D deficiency:

      http://ajcn.nutrition.org/content/87/4/1080S.abstract
      Vitamin D deficiency: a worldwide problem with health consequences1,2,3,4
      Vitamin D deficiency is now recognized as a pandemic. The major cause of vitamin D deficiency is the lack of appreciation that sun exposure in moderation is the major source of vitamin D for most humans. Very few foods naturally contain vitamin D, and foods that are fortified with vitamin D are often inadequate to satisfy either a child’s or an adult’s vitamin D requirement.

      And this problem becomes much worse during the winter, as well as yearround for certain populations, such as the elderly, or for blacks. And as I mentioned above, Black Americans – who reportedly have the highest CV-19 death rates ALSO have a much higher rate of Vitamin D deficiency than average:

      https://academic.oup.com/jn/article/136/4/1126/4664238 Vitamin D and African Americans Susan S. Harris The Journal of Nutrition, Volume 136, Issue 4, April 2006, Pages 1126–1129,
      “Vitamin D insufficiency is more prevalent among African Americans (blacks) than other Americans and, in North America, most young, healthy blacks do not achieve optimal 25-hydroxyvitamin D [25(OH)D] concentrations at any time of year. This is primarily due to the fact that pigmentation reduces vitamin D production in the skin. . . . Clinicians and educators should be encouraged to promote improved vitamin D status among blacks (and others) because of the low risk and low cost of vitamin D supplementation and its potentially broad health benefits.”

      As far as Covid-19 goes, I find this report from Psychology Today reasonably credible report:

      https://www.psychologytoday.com/us/blog/social-instincts/202005/research-suggests-link-between-vitamin-d-deficiency-and-covid-19-deaths

      “Key findings:
      • “A majority of COVID-19 cases with vitamin D deficiencies died.
      • The odds of death were higher in older and male cases with preexisting conditions and lower than normal Vitamin D levels.
      • When accounting for the effects of age, sex, and comorbidity, vitamin D status is strongly related to COVID-19 mortality.

      This research adds to a growing body of scientific literature linking vitamin D to COVID-19 severity. A recent report released by Mark Alipio of Davao Doctors College in the Philippines found that normal vitamin D levels were more likely to be observed in patients with mild cases of COVID-19. To be specific, he estimated that normal vitamin D levels increase the odds of having a mild clinical outcome by approximately 19.6 times.”

  8. Dr. Greger says in the video that ACE inhibitor drugs taken to reduce high blood pressure may have an effect that exacerbates the impact of corona virus. Does that mean that drinking hibiscus tea, which is said the act like an ACE inhibitor, could leave you open to a greater threat from corona virus?

  9. Still looking at wound healing and thought it was interesting when I read that stress makes wound healing take substantially longer.

    They studied it in students and caregivers of Alzheimer’s patients.

    They gave a lot of mechanisms.

    The hypothalamic-pituitary-adrenal and the sympathetic-adrenal medullary axes regulate the release of pituitary and adrenal hormones. These hormones include the adrenocorticotrophic hormones, cortisol and prolactin, and catecholamines (epinephrine and norepinephrine). Stress up-regulates glucocorticoids (GCs) and reduces the levels of the pro-inflammatory cytokines IL-1β, IL-6, and TNF-α at the wound site. Stress also reduces the expression of IL-1α and IL-8 at wound sites—both chemoattractants that are necessary for the initial inflammatory phase of wound healing (Godbout and Glaser, 2006; Boyapati and Wang, 2007). Furthermore, GCs influence immune cells by suppressing differentiation and proliferation, regulating gene transcription, and reducing expression of cell adhesion molecules that are involved in immune cell trafficking (Sternberg, 2006). The GC cortisol functions as an anti-inflammatory agent and modulates the Th1-mediated immune responses that are essential for the initial phase of healing. Thus, psychological stress impairs normal cell-mediated immunity at the wound site, causing a significant delay in the healing process (Godbout and Glaser, 2006).

  10. According to a new article in Nature, there’s now the possibility that covid-19 infection may itself be a risk factor for diabetes

    ‘Mounting clues suggest the coronavirus might trigger diabetes
    Evidence from tissue studies and some people with COVID-19 shows that the virus damages insulin-producing cells.’
    https://www.nature.com/articles/d41586-020-01891-8?

        1. I am not trying to provide advice merely referring to articles in the scientific literature. And yes, my interpretation of the article is that it implies that co9vid 19 increases the risk for a form of late onset diabetes …. perhaps a type of LADA or type 1.5 diabetes. It’s not clear why you think somebody is seeking or that I am proffering advice. In any case, an entity calling itself JazzBass shouldn’t really be mocking other people’s pen names.

          To be honest, I think it would be helpful if you stopped offering your political fantasies and ‘alternative’ opinions. Let’s just stick to what the evidence shows. I have no interest in your opinions about Israel and the Palestinian territories, however fashionable they might be. The Israelis might not be a particularly pleasant bunch but the genocidal religious lunatics who run the Gaza Strip seem a hundred times worse. They make Fatah look like a bunch of easy going hippies. Israel might have been created by terrorist mass murderers in the form of the Irgun and the Stern gang but it seems a bit unreasonable to expect them to cut their genocidal enemies any slack.

          I’ve always suspected that some modern jazz is just a harsh, pretentious and discordant noise. Unkind of me I know but your posts have only reinforced that impression.

          1. Thank you MR. Fumblefingers,

            First of all, wow. You misread my post I guess. I didn’t say you were providing advice, I asked, why seek it from you. (rather than from Greger or independent research. I could have not posted I guess, its true.)

            This illustrates there are fine points one can understand in written language and in music if one is open minded.

            If facts are your language of choice, then why offer your own opinions and share links of others opinions?

            I’m now clear that your position is that a country formed in terrorism, with its majority population reeling for less than one minute after the Brittish pulled out and turned a blind eye to the new self appointed regime, with back door 3rd party self interested approvals, should cut no “slack” to peoples who may respond to the injustices served to them. The victims of the victims if you will. No dispute that the whole thing was terrible, but like the child beater who then grows up and beats his own child, I suggest that, my friend, “seems unreasonable”.

            If my posts seem discordant, it says little to your own concept of harmony. One mans discordance, as in, “ewe, yuc!”, is another mans atonal harmony, and beautiful.

            Speaking of harmony, modern jazz is for the open minded, and like my posts, you simply may not be getting it. One is not required to like Arnold Shoenberg’s assertions, but trust me there is beauty beyond the typical forms we may have grown up with.

            Speaking of facts, I’m not getting what you mean about genocidal lunatics? Glad you are hip to the stern gang, that’s a start, but after reading your post it brings me back to my own post re: compartmentalization.

            You are suggesting the Palestinians are perpetrating what genocide exactly? Concerning genocide, one would find that the actions of Israel are not only illegal in international courts, but too, fit well under the definition of genocide. Its ironic and discordant, I know. For just one instance, if you make a habit of cutting down the olive trees of a culture who’s identity is historically connected with that agriculture, you are in fact committing one component of genocide. There’s way more, but you can read up on it if there’s any interest. One could start with Israeli soldiers who have come out

            My posts offer views backed in facts, but I do not play the game of posting links to then be countered with opposing links or labeling my views with not just some academic snobbery, as ‘alternative’, as if this entire site isn’t based on what the similarly close minded public deems as ‘alternative’.

            And certainly if I posted fact after fact on these issues, it wouldn’t change your view I suspect.

            Rather I feel it best to drop ideas in the hopes that the open minded will read a book or two which contrasts the prevailing cordant view.

            You may not be interested in my posts, or my music. It ok. Really.

            I would add that is is unlikely that anyone could understand the struggle in the black lives matter conflict for instance, if they cant draw a connection to the Palestinian or native American struggle against years and years of oppression, and why it may have been that they rose up, sometimes in violence, not unlike Nelson Mandelas own ANC which had too, a military wing. He’s known as a man of peace. There are so many injustices you may feel free to read up on within the context of compassion towards the boiling oppressed. The native americans too were often called lunatics, I’m sure you know, not to be cut ‘slack’ as well, and even today many will call black protesters crazy lunatics. “Look at ’em, just violent and looting!”

            Perhaps the cordant oversimplify things at times for more palatability?

            I have no political fantasies, rather I have information which most do not care to look for, and not usually on mass media, but ironically once surfaced, does in fact become content on mass media. Go figure. I can say that I rarely take information as fact without first looking into the subject. If there is even one thing Ive said that you think is a fantasy, I’m here and ready to answer any question you may have, since facts is your stated language. I wont find your question discordant, if its genuine, its how we get outside our own heads.

            Now, moving on, I’m willing to forgo political talk here, in the hopes that others will also restrict labeling divergent views with labels of conspiracy etc…and instead consider them as equally unproved ideas to their own. At main issue though, is that one cannot scream out the problems associated with Covid for instance, and not expect to discuss causal factors related to sociopolitical forces which are, and this is important, the larger issue.

            Ok fine, lets talk about masks, and lets guess and post links to scientific ideas which we believe may help, but by all means lets not get discordant and discuss the other things in our society we would absolutely have to change in order to get substantive long lasting solutions – I don’t mean a vaccine.

            Perhaps alternative ideas could find their way to the feeling of possibility even if vastly different to the consensus.

            All that said, why don’t we both then stop giving our interpretations, and ask more questions?

            With that, if anyone was on the call, since I missed it, what was the verdict? Cyano or methyl for B-12? Why, and where to get it.
            These would be facts presented, not interpretations please.

    1. Tom,

      I saw that, too.

      COVID and diabetes is an interesting topic because some of the more serious complications came to what they called new diabetics and it being able to cause it is terrifying.

  11. Almost finished How to Survive a Pandemic and must say it is terrifying to say the least.

    I noticed that many of the citations supporting and describing the imminent HPAI pandemic that transfers easily from human to human are from 2005.

    Is Dr Greger surprised that this disaster hasn’t happened already? 15 years is a lot of ‘borrowed time.’

    1. We are lucky that this one is a relatively mild one for most people.

      We are days away from 500,000 deaths but most of the people who got it barely had any symptoms.

  12. My cousin contacted me today and even though he spent half of the week in the hospital for his lungs the few days he was able to use the PEMF and infrared already have helped a little.

    Up until this week their answer was always zero change and that he was starting gangrene and needed a vascular surgeon.

    2-1/2 days of infrared and PEMF and the answer was, “There is a small improvement.”

  13. A May Clinic doctor said that young people may be left sterile from COVID because of ACE2 receptors involvement in fertility.

    He gave a very big list of long term problems.

  14. If compromised endothelial function and undiagnosed hereditary thrombophilia are in fact key factors in determining who is at risk of severe illness and death from COVID-19, there are two very inexpensive tests available for widespread screening to identify those people, so that those identified as high risk could take more precautions against being infected with the virus and could be immediately hospitalized and treated aggressively if they do test positive. Perhaps Dr. Greger can weigh in on this theory.  Locking down the healthy population is a ridiculous strategy if it turns out to be the case that those at highest risk of death could be easily identified with two tests that each cost under $100.

    “Now, researchers have woven these findings into a new hypothesis explaining why some patients slip into a fatal “second phase” of COVID-19, 1 week or so after hospitalization. The key is direct and indirect damage to the endothelial cells that line the blood vessels, particularly in the lungs, explains Peter Carmeliet, a vascular biologist at the Belgian research institute VIB and co-author of a 21 May paper in Nature Reviews Immunology. By attacking those cells, COVID-19 infection causes vessels to leak and blood to clot. Those changes in turn spark inflammation throughout the body and fuel the acute respiratory distress syndrome (ARDS) responsible for most patient deaths….This mechanism could explain why the disease pummels some patients who have obesity, diabetes, and cardiovascular conditions: The cells lining their blood vessels are already compromised. …The array of pathways may also explain why some young people without known risk factors for COVID-19 become seriously ill: They might have undiagnosed clotting or autoimmune disorders, such as rheumatoid arthritis, that amplify the effects of SARS-CoV-2 infection….Another commonly prescribed drug might help: statins. Typically taken to lower cholesterol, they also reduce inflammation and improve endothelial cell function.” https://www.sciencemag.org/news/2020/06/blood-vessel-attack-could-trigger-coronavirus-fatal-second-phase

  15. Thanks for the article. This would have been a good place to mention the flurry of recent studies re: vitamin D vs Covid-19. The results have been consistent. These studies, maybe 6 or so now, have all shown that the folks with the lowest blood levels of vitamin are the ones who end up in ICU. One study out of Louisiana even showed that, for folks under age 75, of the ones with CV-19 that needed ICU, 100% had insufficient or deficient vitamin D in their blood. ONE HUNDRED percent. But those in the hospital with CV-19, but who did not need ICU, a much lower percentage of those were deficient in vitamin D. A study out of the Philippines was similar, something like 96% of severe cases were deficient, while only 4% were sufficient(30 ng/ml or more). Mils cases it was the reverse: about 96% were sufficient, only 4% insufficient. Another study actually gave some vitamin D to their C-19 patients(along with B12 and a couple of other vitamins/minerals, maybe Magnesium and zinc, not sure) and the group that got a measly 1000 IU per day of vitamin D did MUCH better then the group that did not when it came to worsening and needing oxygen support or ventilation. So there seems to be something here, as well as with IV vitamin C. Dr. Greger, this would make a great subject for a future video! IMO anyway.

    1. Bill,

      The studies that document immune competence. with even minimal input of some mineral/vitamin levels, gives us new rational to maintain some optimization via both diet and supplementation. Too bad this information is not mainstream and being included with masks and distancing……

      Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

      1. I agree, too bad it is not being publicized. I feel there is, at a minimum, the potential to have saved thousands of lives with very little risk or cost. But it appears that “they”, being our government and medical authorities ( Dr.Fauci, for one example), simply refuse to inform the public. If they don’t inform us because they don’t know, then there is no excuse for such ignorance.
        Bill

  16. And same can be said for IV vitamin C, with or without such adjuncts as methylprednisolone etc ( Research Dr. Marik et al and Frontline Critical Care Working Group FLCCC ). Probably extremely helpful, but the public has not been informed of this by our government/medial authorities. There was a very brief notce that several NYC hospitals were giving IV vitamin CV-19 patients upon hospital admission, as well as a big study being done in China, but not a word since then, either for or against. Except for a couple of days later news of the FBI raiding a clinic in Michigan because they dared to give IV vitamin C for CV-19.

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