Extremely vulnerable groups, such as transplant recipients, those with certain cancers, respiratory conditions, metabolism issues or on immune suppression medication are being asked to self-isolate for longer than most, becuse they are at more risk for developing complications associated with COVID-19.
However, those with diabetes and prediabetes have NOT been given this advice – and the newest thinking is that they are just as much at risk. However, the good news is that many people with high blood sugar can make positive changes in their diet and lifestyle to reduce this risk and improve their immune response.
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What is becoming more apparent is that diabetes now seems to be the highest risk factor for mortality rates and has overtaken those cases with cardiovascular disease and from cancer in Hong Kong. A study published last year by the American Society for Clinical Investigation on a similar coronavirus, MERS-CoV, also found that diabetes was particularly closely linked to immune dysregulation and enhanced disease severity.
This week I listened to a US interview with Dr Stephen Smith of the Smith Center of Infectious Diseases and cardiologist Dr. Ramin Oskoui who are also seeing this trend in America and are now finding a strong pattern between high blood sugars and severity of illness. Diabetics are most at risk, but they also think that those with high blood sugars and pre-diabetes are also very vulnerable to complications. This might be an important piece in the Covid-19 puzzle and may explain why some people without full blown diabetes are affected more than others.
Our own UK cardiologist Dr Aseem Malhorta has also been speaking up with his concerns about our nation’s health and urging us Brits to take diet and lifestyle more seriously, as a large number of our nation are very vulnerable to be hit hard by Covid-19. He is concerned that those with metabolic disease including those who are overweight or obese and those with high blood sugar and diabetes have dysregulated immune systems affecting the ability of their white blood cells to fight infection. Dr Malhorta has been banging his drum over the past few years about the link between diet, lifestyle and metabolic issues like diabetes and cardiovascular health and never has it been a more poignant time to do something about it.
It is well established that type 1 diabetics struggle with immunity, but it also known that that prediabetics suffer from low grade inflammation affecting their immune system. Those with prediabetes and insulin resistance are known to develop pulmonary weakness during the prediabetes stage, so this is possibly why they are developing such bad symptoms even if they do not have diabetes yet.
What is Diabetes?
Diabetes is a condition where blood sugar levels are dysregulated and can potentially affect all age groups. There are two main types of diabetes – type 1 which is autoimmune-mediated and type 2 which metabolic condition with a marked sugar/glucose intolerance. Type 2 diabetes can affect both overweight and slim people, although most fit into the overweight or obese category. Prediabetes is a state when someone regularly has higher than normal blood sugars and is on the path for developing type 2 diabetes.
Type 1 diabetes cannot be reversed, but a healthy diet rich in healthy fats and proteins as well as vegetables can help somewhat to keep blood sugars regulated. Prediabetes and type 2 diabetes however can be reversed within days or weeks if the right steps are made to diet and lifestyle.
There are over 330,000 people with type 1 diabetes in the UK and the UK has the world’s 5th highest rate of type 1 diabetes in children. Since the mid-nineties, the total number of people diagnosed with diabetes in the UK has risen from 1.4 million to 3.8 million, the vast majority of which are thought to be type-2 diabetics. Taking into account the number of people likely to be living with undiagnosed diabetes or are in a prediabetic state, it is thought around 12.3 million people in the UK are at risk for developing type 2 diabetes. We have over 7,000 kids in the UK with type 2 diabetes which has risen very dramatically only in a few years, the first children only being diagnosed in 2000. So, it’s not just the mid-lifers and elderly we need to look out for.
So, what can you do to help regulate your blood sugars?
Here are some simple measures you can take to help regulate your blood sugars and optimise immunity. Take one step at a time as ideally you want to make this part of your normal day to day routine, so you take measures both for the short and the longer term:
Cut back on ultra-processed food – convenience food now fills over 50% of our shopping trollies and these tend to be high sugar and high in refined white carbohydrate. These ingredients are known to pose higher risk for becoming overweight and obese as well as diabetes. Cutting back on crisps, pizzas, chips, biscuits and sweetened fizzy drinks should be the first step to support blood sugar levels.
Cook from scratch – the food we cook ourselves is generally fresher and more nutritious than ready-made convenience food. Since we are spending more time with our families at home at the moment whilst we are in lockdown, then this is a great opportunity to learn more about foods that help balance blood sugars and work out recipes that you as a family can enjoy.
Choose healthy low-glycaemic ingredients – it is thought that a low carbohydrate diet can put some cases of type 2 diabetes into remission. These are foods that do not spike your blood sugars and help to maintain even energy throughout the day. These include vegetables, salads, pulses, nuts, seeds, meat, poultry, tofu, eggs, whole dairy products, cold pressed oils, herbs and spices. Keep low on fruit and even wholegrains whilst you are getting the blood sugar better regulated.
Eat more protein – for many type 2 diabetics, it is thought that 20–30% of total food should be in protein. However, a study done in 2016 a high protein diet gave 100% remission to a group of pre-diabetes and a significant improvement in their metabolic parameters and pro-inflammatory markers. Eggs seems to be a particularly good option and do not pose risk to high cholesterol, as it was once thought.
Choose healthy fats – olive oil in particular has been shown to help manage post-prandial blood glucose levels, so your blood sugars do not shoot up after eating. Try pouring a glug onto your food before eating and use it in salad dressings. The olive oil is one of the key reasons why a Mediterranean diet is recommended for stabilising blood sugars which also includes omega 3 rich fish, nuts, seeds, cheese and avocado, rich in healthy fats. It is the switch from highly processed soya, sunflower and corn oils used in ultra-processed foods to extra virgin olive oil and omega 3 rich foods in oily fish, flax, chia, and walnuts that help to reduce inflammation and stabilise blood sugars.
Cut back on snacks – aim to eat three nutritious meals a day and try not snack in between. Ideally leave a 12-hour window between your evening meal and your breakfast without eating. This overnight fast will help to feed the Akkermansia bacteria in the gut microbiome which helps to regulate weight and blood sugars.
Bolster your gut microbiome – those with prediabetes have been found to have very low Akkermansia bacteria in their gut. As well as fasting overnight and cutting back on snacking, Akkermansia can be bolstered by eating a diet rich in polyphenols, which are the coloured pigments in fresh fruits, vegetables, cocoa, green tea and foods high in antioxidants including cranberry, black & red grape, blackcurrant and pomegranate. Aim to “Eat The Rainbow” of fruit and veg every day. Fructo-oligosaccharides (FOS) prebiotic foods also feed Akkermansia, and these are found in fruits and vegetables such as unripe green bananas, onions, chicory root, garlic, asparagus, and leeks. Aim to eat at least 30 different plant-based foods every week to support a healthy microbiome and your blood sugar levels. This can include different lettuce leaves or different coloured peppers: red, orange, yellow and green.
Get a good night’s sleep – We are used to a 24/7 society these days and this is driving many of us to skip on important sleep. A lack of sleep can mean you are more likely to grab unhealthy foods during the day, and if you sleep more you will probably find it easier to eat more healthily and regularly. It is known that if you regularly miss out on a few hours of sleep, you are more likely to develop type 2 diabetes and to put on excess weight and so good sleep hygiene is important. This includes turning off screens at least an hour before bed and giving plenty of time to wind down before bed.
Vitamin D and sunshine – Spending time in your garden or open spaces, enjoying some sunny rays when the sun is out will help to boost up your vitamin D levels. Adequate Vitamin D also helps to bolster the gut microbiome and has also been found to support better glucose regulation. If you can’t get out in the sun then a diet rich in oily fish, grass fed meat, eggs, mushrooms and cheese can give you a little vitamin D. The government recommends we take a Vitamin D supplement from October through to March, but with such a long and hard winter this year and a nasty virus afoot, it may be prudent to extend this until the end of April.
Move more – whether this is kicking a ball in the garden, squats in the kitchen or doing an online exercise class, your blood sugars and immune system will be thankful for some exercise. It is thought that quick high intensity exercise is best but regular walks and getting the heart pumping a little will still help a large number of people. But don’t overdo it with Coronavirus around, as extreme exercise can lower the immune system in the short term.
If your blood sugars run high or you know in your heart of hearts that you eat far too many sugary and carb-heavy convenience foods, then this might be THE MOST IMPORTANT reason to take positive steps to change your diet and lifestyle. And finding ways to regulate your blood sugars in a better way could be a game-changer!
- Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study https://www.thelancet.com/pb-assets/Lancet/pdfs/S014067362305663.pdf
- Diabetes and COVID‐19 https://onlinelibrary.wiley.com/doi/full/10.1111/1753-0407.13027
- Comorbid Diabetes Results in Immune Dysregulation and Enhanced Disease Severity Following MERS-CoV Infection https://insight.jci.org/articles/view/131774
- Diabetes UK – Facts & Stats https://www.diabetes.org.uk/resources-s3/2019-02/1362B_Facts%20and%20stats%20Update%20Jan%202019_LOW%20RES_EXTERNAL.pdf
- Longitudinal Multi-Omics of Host-Microbe Dynamics in Prediabetes https://www.nature.com/articles/s41586-019-1236-x
- Insulin Resistance, Prediabetes, Metabolic Syndrome: What Should Every Pediatrician Know? http://cms.galenos.com.tr/Uploads/Article_16629/JCRPE-9-2-En.pdf
- Breaking down the facts and fear-mongering of coronavirus https://www.msn.com/en-us/news/us/breaking-down-the-facts-and-fear-mongering-of-coronavirus/vp-BB11NYr8
- Corona Virus and The Elephant in the Room Sky News https://www.youtube.com/watch?v=CHAnzhRZFZ0
- Lung Function Measurements in the Prediabetes Stage: Data From the ILERVAS Project https://link.springer.com/article/10.1007%2Fs00592-019-01333-6
- Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report https://care.diabetesjournals.org/content/42/5/731
- Dietary Protein Is Important in the Practical Management of Prediabetes and Type 2 Diabetes https://academic.oup.com/jn/article/145/1/164S/4585788
- Remission of pre-diabetes to normal glucose tolerance in obese adults with high protein versus high carbohydrate diet: randomized control trial https://drc.bmj.com/content/4/1/e000258
- Low-carbohydrate Diet in Diabetes Mellitus Treatment https://pubmed.ncbi.nlm.nih.gov/30441982/?from_term=Remission+of+prediabetes+&from_pos=3
- Effect of a High-Egg Diet on Cardiometabolic Risk Factors in People With Type 2 Diabetes: The Diabetes and Egg (DIABEGG) Study-randomized Weight-Loss and Follow-Up Phase https://academic.oup.com/ajcn/article/107/6/921/4992612
- Mediterranean Diet Improves Endothelial Function in Patients With Diabetes and Prediabetes: A Report From the CORDIOPREV Study https://linkinghub.elsevier.com/retrieve/pii/S0021915017314314
- Extra Virgin Olive Oil Improves Post-Prandial Glycemic and Lipid Profile in Patients With Impaired Fasting Glucose https://linkinghub.elsevier.com/retrieve/pii/S0261561416301121
- Nutrition in Prediabetes https://pubmed.ncbi.nlm.nih.gov/16570763/?from_term=healthy+fats+prediabetes&from_pos=4
- Role of sleep duration in the regulation of glucose metabolism and appetite https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018785/
- Associations Between Sleep Loss and Increased Risk of Obesity and Diabetes
- The Important Role of Sleep in Metabolism https://pubmed.ncbi.nlm.nih.gov/24732925/
- The contribution of modern 24-hour society to the development of type 2 diabetes mellitus: the role of insufficient sleep https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6932842/
- Exercise and Type 2 Diabetes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/
- The impact of brief high-intensity exercise on blood glucose levels https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587394/
- Aberrant Intestinal Microbiota in Individuals With Prediabetes https://pubmed.ncbi.nlm.nih.gov/29379988/
- Vitamin D and Prebiotics May Benefit the Intestinal Microbacteria and Improve Glucose Homeostasis in Prediabetes and Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/23823585/