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Deep Compartment, Deep Trouble
The two things that really put you at risk for not just covid but practically every other large contributor to mortality are age and obesity. One of these we have no control over and the other is so difficult that even bothering to argue for it is considered a waste of time. The fat in our body plays a vital and important physiologic role, it acts like a highway of interconnected tissue allowing hormones to be distributed widely. A diet plentiful in calories but insufficient in fat will still lead to starvation. It is essential to our survival and demonization or idolization by popular diets both miss the bigger picture. Excess fat leads not only to a bigger waistline and higher scale readings but the growth of an organ that will now work against you as opposed to for you.
Excess obesity is associated with a wide variety of negative downstream endocrine issues. Insulin resistance is the first step down the long rabbit hole of hormonal dysregulation. As your body’s insulin becomes less effective your insulin levels will rise to compensate. Growth hormone production will be decreased and its metabolism increased resulting in lower circulating levels of growth hormone which is vital to muscle synthesis and exercise capacity. The hypothalamic pituitary adrenal axis regulates your production of the stress hormone cortisol and the entire system is over-responsive in obese patients. In males, testosterone, sexual hormone binding globulin, and gonadotropin releasing hormone are all decreased. In females, testosterone will be increased and this combined with insulin resistance can lead to polycystic ovary syndrome.
Your adipose tissue produces chemicals known as adipokines, dysfunctional secretion of which has been associated with obesity. The authors of a recent study identified some of these adipokines that appear to be altered during covid infection. Adiponectin is one that is associated with anti-inflammatory and anti-diabetic properties and despite being a cytokine secreted from fat cells it is lower in obese patients. Compared to other ICU control patients those with covid ARDS showed a 50% reduction in adiponectin. Animal studies have also shown a decrease in adiponectin during infection. Adipsin which is known to promote insulin secretion and beta cell survival was also lower in the covid ICU patients compared to controls. Loss of these beneficial cytokines is likely aggravating the immune response and worsening insulin resistance. The researchers would go even further and be the first to prove the virus could infect our adipose tissue itself and suggest it likely drives dysfunction that contributes to hyperglycemia.
While obesity and hyperglycemia have been clearly associated with worse outcomes this recent evidence suggests possible mechanisms behind this correlation. If the virus is able to sequester itself in our adipose tissue that could explain some of the lingering effects from infection. Our adipose tissue could be acting as a deep compartment filling up with virus particles during infection to be slowly released later. The problem with deep compartments is at some point they may get filled up and when that happens you are in deep trouble. Obesity’s role in the pandemic has been obvious all along and it should infer that weight loss would be the primary preventative treatment for covid.
Despite all this evidence the most obvious answer to blunting the pandemic’s deadly impact goes ignored and unmentioned. Far less effective things like mask mandates and social distancing have been strongly encouraged to say the least and outright harmful things like lockdowns have been prescribed from on high as the solution to the pandemic. Some areas have created and enforced a two-tiered society to separate the vaccinated from the unvaccinated which is evil but also clearly ineffective. First, it is very difficult to prove who is actually “fully vaccinated” not just because what that term means will evolve almost as fast as the virus itself but what is your proof? That piece of paper anyone could print at home? Unless they are short of breath or complaining of chest pain it can be hard to tell by looking at someone if they are vaccinated or not. Forcing us to rely on some dystopian vaccine passport or electronic version thereof seems unlikely, I can’t even get people to fill out their booster paperwork online.
So where is the weight loss mandate? How can something so simple, easy, and free be so completely ignored? It would also be incredibly easy to enforce, no paperwork needed, it is quite easy to tell who is in violation. I don’t like the idea of lockdowns or mandates but if you have already gone that far why is throwing a Peloton in the package anymore absurd. If a failure to vaccinate makes you a threat to public health, then that same argument certainly applies to obesity. It is very curious that medical tyranny over your body stops so completely at fat-shaming. As for your age and what we can do about it, well the 1976 sci-fi classic Logan’s Run is worth a watch for its unique approach to elder care.
Jacob Hyatt Pharm D.
Father of three, Pharmacist, Realtor, Landlord, Independent Health and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Further Reading and References
Kokkoris P, Pi-Sunyer FX. Obesity and endocrine disease. Endocrinol Metab Clin North Am. 2003 Dec;32(4):895-914. doi: 10.1016/s0889-8529(03)00078-1. PMID: 14711067.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443335/
Reiterer M, Rajan M, Gómez-Banoy N, Lau JD, Gomez-Escobar LG, Ma L, Gilani A, Alvarez-Mulett S, Sholle ET, Chandar V, Bram Y, Hoffman K, Bhardwaj P, Piloco P, Rubio-Navarro A, Uhl S, Carrau L, Houhgton S, Redmond D, Shukla AP, Goyal P, Brown KA, tenOever BR, Alonso LC, Schwartz RE, Schenck EJ, Safford MM, Lo JC. Hyperglycemia in acute COVID-19 is characterized by insulin resistance and adipose tissue infectivity by SARS-CoV-2. Cell Metab. 2021 Nov 2;33(11):2174-2188.e5. doi: 10.1016/j.cmet.2021.09.009. Epub 2021 Sep 16. Erratum in: Cell Metab. 2021 Dec 7;33(12):2484. PMID: 34599884; PMCID: PMC8443335.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447553/
Cordeiro A, Ribamar A, Ramalho A. Adipose tissue dysfunction and MAFLD in obesity on the scene of COVID-19. Clin Res Hepatol Gastroenterol. 2021 Sep 17;46(3):101807. doi: 10.1016/j.clinre.2021.101807. Epub ahead of print. PMID: 34543756; PMCID: PMC8447553.
https://pubmed.ncbi.nlm.nih.gov/34899613/
Mohajer N, Du CY, Checkcinco C, Blumberg B. Obesogens: How They Are Identified and Molecular Mechanisms Underlying Their Action. Front Endocrinol (Lausanne). 2021 Nov 25;12:780888. doi: 10.3389/fendo.2021.780888. PMID: 34899613; PMCID: PMC8655100.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607179/
Mahrooz A. Insulin resistance as a common clinical feature in diabetes mellitus, obesity, hypertension, dyslipidemia, and atherosclerosis deserves more attention in COVID-19. J Res Med Sci. 2021;26:98. Published 2021 Oct 18. doi:10.4103/jrms.JRMS_1063_20
Published in Healthcare
It’s ignored because it implies personal responsibility. Shallow drones and leftists control the medical institutions, and they do not want to hear about personal responsibility.
“So where is the weight loss mandate? How can something so simple, easy and free be so completely ignored? “
I’m sure all this info is accurate and I don’t dispute any of it. But I know for a fact that a weight loss mandate is neither simple nor easy. Having been threatened with losing my military career because of a high BMI I have first hand knowledge what a weight loss mandate is. I struggled for years, and still do, to loose weight.
Losing weight via exercise is extremely difficult. I had success if I spent 90 minutes at 80% max heart rate doing cardio, 5-6 times a week. Anything less produced no result. Weight lifting caused a weight gain which is OK for a civilian, not acceptable for a military member under a “mandate”.
The only diet I had success with was the Atkins diet.
And there is not one simple solution to loosing weight. I know that things that worked for me might not work for someone else.
The government recommended food pyramid showed that carbs should be the largest part of ones diet. Thanks Uncle Sam – that did me a lot of good. See below.
If loosing weight was simple and easy there would be a lot fewer obese people! A government mandate is not the answer.
I don’t want an obesity mandate, but I do agree that our concerns are misplaced. Instead of mask mandates and vaccine wars the discussion should be about healthy eating, weight loss, and general fitness. This tendency to fight over ancillary issues because the real issue is too painful to address is a real problem in our country.
I think most people are not aware that their fat is actually acting as an organ and isn’t just fat cells just taking up space. I think it’s fascinating.
There are plenty of statistics available comparing today’s average adult weight with that of 50 years ago. George McGovern may not have been elected president, but his report in 1977 got the federal government involved in nutrition guidelines. We went from four food groups to pyramids and plates and confusion. Food manufacturers sold gimmicks (100 calorie snack packs!), and restaurant portions skyrocketed as people ate out more often. I don’t think that having the government involved in nutrition guidelines has been successful, and I don’t think doubling down would be helpful.
Unfortunately weight loss is simple, and challenging: calories in and calories out. I don’t thin you can lose weight by exercising. You have to count calories and achieve a deficit.
Exercise can lead to weight loss, it’s just that calories are large units of energy so you need to exercise a lot to get the calories burned to exceed calories consumed.
@jacobhyatt this is where you can talk about appetite suppressant drugs. There are lots of them out there. I take Saxenda (liraglutide) which I believe is a version of the hormone that triggers fullness, just modified to last much longer.
If losing weight were easy, people would do it.
I have no knowledge of appetite suppressants.
If I do keto for a few days, I get a natural suppressant and can fast for many hours.
For me, the trick is letting the body consume itself. Fasting needs to be a regular part of life.
Decades ago, multiple fast-food outlets on every corner began to make it easy to eat any time, or all the time. It used to take some work to eat a meal: go to the store and buy stuff, bring it home, clean the veggies, defrost meats, mix things together. turn on the stove/oven, cook things till they are done, serve them up to the family, clean the table, wash dishes/pots/pans, put everything away.
Now it’s a five-minute car ride to eat your fill of burgers, fried chicken, pizza, tacos, whatever. No muss, no fuss.
Your thinking is backward.
The mandate is wrong. All mandates are wrong.
When the government does it, it has the power of enforcement.
This is the nub of totalitarianism: that your body and your life belong to the State to control as it wishes.
This is wrong on every level and in every way.
No vaccine mandate. No weight loss mandate.
People engage in all kinds of risky behavior. You start regulating and punishing one type, you’ll have to do them all.
We had a great healthcare system. We need to restore it.
And then the diet industry said that eating small meals throughout the day will stave off hunger and help you lose weight. Define small meal.
This reminds me of a story a few years ago about an airline that wanted to charge folks for their seats based on their weight. You can imagine how that went.
I always wished that food labels would eliminate all the mumbo jumbo that almost nobody understands and just have a simple “eating this will have to be worked off by X hours on a treadmill.
This was a great post but respectfully, most will be turned off by its length and technical language. This is too important to be relegated to the waste bin for such reasons. Just one simple man’s advice.
Best drug ever for weight loss was orlistat but you had to buy new underwear. We compound a naltrexone/bupropion/chromium capsule at my pharmacy that has good results as well.
I was hoping the logans run joke at the end would key into the satire element. I don’t want any mandates of any kind trying to highlight the absurdity of the mandates and their ultimate conclusion was my goal. Your right it will never end so let them push further and continue to alienate the electorate.
Sorry. :-) I didn’t know what the reference was. I’ve heard of it but I’ve never seen it.
I am so happy to hear this is satire. I read a book about fifteen years ago talking about “smart clothes” that would monitor what diabetics ate from moment to moment and when they took their medication. This would be paid for by the insurance companies, who would then be able to adjust premiums in real time. It was a very freaky idea. I’ve been hypersensitive to this issue ever since.
Again, I’m sorry to not have realized that. :-) :-)
Yeah, I missed that too. Sorry. I’m just touchy about this topic – I’m sure you could tell.
It should be obvious that obesity has a major genetic component. Pacific Islanders for example:
Native Hawaiians/Pacific Islanders were three times more likely to be obese than the overall Asian American population in 2014.
Also, high carb diets are a major factor. Gary Taubes presents a lot of supporting research in his books.
High fructose corn syrup.
Except it’s not the same for all people.
Liraglutide is a member of a class of drugs called “glucagon-like peptide 1 analogs(Byetta/bydureon, victoza [brand name for liraglutide in the diabetes treatment dose formulations], ozempic/rybelsus, trulicity). These are currently the most effective drugs for weight loss other than methamphetamines, which are not usable for long term obesity management. Other than that, you have gastric bypass surgery. While bypass surgery is covered by insurance, medical management of obesity is not covered by insurance generally. Why not? Your insurance would likely be completely unaffordable. So, in the words of the preacher to the new sheriff in “Bazing Saddles”: Yer on yer own!
I’ve been told the secret to weight loss is to eat less and exercise more.
I have no first hand knowledge if this is true.
Diabetic friend of mine tried Byetta for a while, seemed to have some side effects, but I don’t know if those are common.
There’s no profit in telling people to lose weight. Imagine the backlash from major food and soda corporations if Biden or Fauci told people to cut back on the amount of soda and processed foods they consume. Get vaxxed and boosted, put on a mask and stay fat. Phizer and Kellogg’s will still stay profitable with this strategy. Our leaders don’t care about public health. Our society is getting fatter and more malnurished and none of them will dare to tell us why.
Phen/phen was a great appetite suppressant until that business about valvular heart disease. The best now is Phentermine (adipex), 15 to 75 mg a day. I don’t like the naltrexone/bupropion combo for my patients but a lot of other Docs use it.
Writing of priorities, I was once reprimanded by a clinic I worked at for prescribing weight loss drugs to my patients with insulin resistance (pre-diabetes). I chose not to work there much longer.
And writing of the FDA food pyramid, that appalling construction has led to more death and disease in America than anything else coming out of Washington before 2020. I remember being in an endocrine conference when it came out and we were all amazed by the sheer stupidity of it. We all knew it would make obesity and diabetes endemic, and it has.
The tax code is also too complicated and I certainly can’t read the whole thing. However I appreciate hearing what folks who have more expertise have to say. I fell the same about the OP.
Didn’t a recent NY mayor try taxing sodas?
I have never seen a doctor willing to prescribe weight loss drugs. I thought they didn’t exist. Everyone seems to sell some kind of complex vitamin supplement thing, but that’s it.
I’m making very slow (SLOW) progress in losing weight. If I maintain this, I’ll be at the right weight in a decade. I can’t seem to manage more than that without something tripping and cravings become unbearable in an attempt to go back to the same size.
There is very strong evidence that the key to obesity will be unlocked in the process of harnessing the beneficial and harmful effects of the gut microbiome. Just look at the results of fecal transplants on obese patients from thin patients and vice versa. You are what you eat may not be nearly as true as you are what your bowel microbes want you to eat.
Can you eleborate on this? Perhaps point to credible sources for further information.
Should be less expensive and less invasive than other courses of action.
There are credible sources all over the medical literature and the broader realm of popular internet reporting on the myriad of studies related to the impact of the gut microbiome on human health, psychology and evolutionary biology. Have at it. The usefulness of this research in a marketable therapeutic regimen seems less than immediate but is very promising.
I just have to eat like @kirkianwanderer…