Why are diabetes, heart disease, hypertertension, and obesity risk factors for mortality from COVID-19?

Diabetes, coronary artery disease, hypertension, obesity are the main “underlying medical conditions” that increase risk of death from Covid19. Does this sound familiar? All are features of metabolic syndrome.  And what is the overarching pathophysiology of metabolic syndrome? Hyperinsulinemia. Hypertension, one of the strong predictors of a bad outcome with Covid19 is not, in an of itself, necessarily associated with impaired immunity.  Most cases of hypertension are associated with metabolic syndrome and hyperinsulinemia. It is not universally agreed, but a, if not the, primary mechanism for the association of hyperinsulinemia and hypertension is the upregulation of the renin, angiotensin, aldosterone, RAAS, system.  One mechanism whereby insulin upregulates the RAAS system is by upregulating ACE receptors.  See links to articles below.  SARS-CoV-2 virus enters cells by attaching to the ACE receptor in lungs.  So it should follow that the more active ACE receptors an individual has, the more opportunity the SARS-CoV-2 virus has to penetrate lung tissue leading to worse disease and mortality. According to a review of NHANES data, 88% of US population is metabolically unhealthy. If you want to improve your chances of surviving Covid19, you need to reverse your metabolic syndrome with a low carb, ketogenic diet.





How to properly use insulin in diabetes and the mechanism of insulin resistance

After 35 years as a primary care physician and now 5 years as a full time hospitalist, I have come to realize that at least 90% of physicians do not know how to properly prescribe insulin for diabetes. To properly dose insulin, you have to know the physiology of normal insulin release in glucose homeostasis and how that then relates to insulin dosing and then what happens in diabetes.

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Keto Diet Fundamentals

Here is an article on fundamentals of a ketogenic diet by @HVMN that is a good summary of the aspects of a ketogenic diet and how it compares to other low carb diet plans:


Keto Diet Fundamentals

Originally published on HVMN by Dr. Brianna Stubbs and Nate Martins.

You’ve heard of the keto diet. Everyone from Lebron James to the Kardashians has used the low-carbohydrate, high-fat diet for reasons like performance and weight loss.

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Low Carb Ketogenic Diet For Weight Loss and Diabetes Control–Getting Started

Quick start Low Carb Ketogenic Diet guide:

Why carbohydrate restriction rather than total calories or fats?

In a nutshell: It’s about insulin.  Insulin has two main functions.  1. It enables glucose to enter cells so they can utilize it for energy. 2. It promotes the deposition of fat into the bodies fat stores. The higher the insulin level, the more fat is deposited into and locked into fat stores.  Carbohydrates are the primary food type that stimulates insulin release. Eating foods very high in sugar and refined carbohydrates causes significant spikes in insulin levels which not only cause more storage of the food you just ate into fat, but also adversely affects your liver and muscle tissues over time causing these organs to become resistant to insulin.

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Low Carb Ketogenic Diet to Treat Diabetes

Low Carbohydrate, ketogenic, Atkins type diet should be the first step in treatment of all diabetics, both type one and two. Numerous studies and practice experience testimonies have confirmed this. See Eric Westman’s second video below. The most comprehensive review of the data supporting using LCHF to treat diabetes was cited in the tremendous article by R D Feinman PhD per this link:

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The Cause of Coronary Artery Disease


The conventional theory of the cause of coronary artery disease has been driven by the so called “Diet Heart Hypothesis.” This was the idea that diets that were high in saturated fats raised blood cholesterol which caused atherosclerotic blockage of arteries. This was started by several flawed studies. The first was done by Nikolai Anichkov in 1913. He found that when he fed rabbits diets that were high in cholesterol, that they developed coronary atherosclerosis. This was and still is considered a groundbreaking study proving the role of cholesterol in heart disease. The problem was that rabbits are herbivores, not accustomed to eating cholesterol as there is no cholesterol in plant foods. Hence their bodies were not adapted to consuming dietary cholesterol.

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What about cholesterol?

The main problem that mainstream medicine and cardiologists have with low carb high fat diets is concern that “eating all that fat” will increase risk for heart disease. This concern was so great that Atkins was called before a senate committee where witnesses said that his diet was malpractice and was like mass murder. The problem is that the “cholesterol, diet, heart” hypothesis was adopted without any substantiating proof. What lead to the diet heart hypothesis was that there is cholesterol in the atherosclerotic lesion in arteries so researchers therefore believed that dietary cholesterol caused these lesions. In 1915 a researcher named Nikolai Anitschkow did a study where he fed rabbits diets high in cholesterol and they developed atherosclerotic lesions in their arteries. The problem was that rabbits

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