Month: April 2023

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Achieving Optimal Metabolic Health: Criteria and Strategies

By Stephen Fitzmeyer, MD

Metabolic health is an essential component of overall health, and it is crucial to understand the criteria necessary to achieve optimal metabolic health. An individual is considered to have optimal metabolic health if their markers meet the following levels: A1C less than 5.7%, blood pressure lower than 120/80 mmHg, waist circumference of 0.5 or less, triglycerides less than 150 mg/dL, and HDL cholesterol 60 mg/dL (1.6 mmol/L) or above.

On the other hand, an individual may be diagnosed with metabolic syndrome if they fail to meet three of the above criteria. Metabolic syndrome is a cluster of conditions that increase the risk of developing chronic diseases, such as diabetes, heart disease, and stroke. It is estimated that over one-third of American adults have metabolic syndrome, emphasizing the need to address this issue.

To achieve optimal metabolic health, a combination of lifestyle modifications and medical interventions is necessary. The strategies to improve metabolic health include regular physical activity, healthy dietary choices, maintaining a healthy weight, smoking cessation, and managing stress. Additionally, medical interventions such as medication management of blood pressure and blood glucose levels may be necessary for some individuals.

Incorporating these strategies into daily life can significantly improve metabolic health and reduce the risk of developing chronic diseases. It is essential to work with healthcare providers to establish personalized goals and develop a plan to achieve them. Regular monitoring of metabolic markers is also crucial to ensure that the interventions are effective.

In conclusion, achieving optimal metabolic health requires a multifaceted approach that includes lifestyle modifications and medical interventions. By meeting the criteria outlined above and incorporating strategies to improve metabolic health, individuals can significantly reduce the risk of developing chronic diseases and improve their overall health and well-being.

Author: Stephen Fitzmeyer, M.D.
Physician Informaticist
Founder of Patient Keto
Founder of Warp Core Health
Founder of Jax Code Academy, jaxcode.com

Connect with Dr. Stephen Fitzmeyer:
Twitter: @PatientKeto
LinkedIn: linkedin.com/in/sfitzmeyer/

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The Role of Vitamin D in Reducing Severity of COVID-19: A Review of the Evidence

By Stephen Fitzmeyer, MD

Introduction:

The COVID-19 pandemic has caused significant morbidity and mortality worldwide. Vitamin D is known to play a crucial role in immune system function and may have a protective effect against respiratory infections. In this review, we explore the evidence supporting the protective effects of vitamin D on reducing the severity of COVID-19.

Body:

Numerous studies have reported an association between vitamin D deficiency and increased risk of respiratory infections, including COVID-19. In a systematic review and meta-analysis, Jolliffe et al. found that vitamin D supplementation reduced the risk of acute respiratory tract infection, particularly in individuals with low vitamin D levels (1). Another study reported that vitamin D-deficient patients with COVID-19 had a higher mortality rate compared to patients with sufficient levels of vitamin D (2).

Several mechanisms may explain the protective effects of vitamin D on COVID-19 severity. Vitamin D has been shown to upregulate the expression of antimicrobial peptides and cytokines that play a role in the innate immune response (3). Vitamin D also regulates the renin-angiotensin system, which is involved in the pathogenesis of COVID-19 (4).

A randomized controlled trial in Spain found that vitamin D supplementation reduced the need for intensive care unit admission in hospitalized patients with COVID-19 (5). Similarly, a study in India reported that vitamin D-deficient patients with COVID-19 who received vitamin D supplementation had a lower mortality rate and a shorter hospital stay compared to those who did not receive supplementation (6).

Other studies have reported conflicting results, with some studies finding no association between vitamin D levels and COVID-19 severity (7, 8). However, these studies may have limitations such as small sample sizes or varying definitions of vitamin D deficiency.

Conclusion:

Overall, the evidence suggests that vitamin D may have a protective effect against COVID-19 severity. Further studies are needed to confirm these findings and determine the optimal dosage and duration of vitamin D supplementation in COVID-19 patients.

References:

1. Jolliffe DA, Camargo CA Jr, Sluyter JD, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583.

2. Jain A, Chaurasia R, Sengar NS, et al. Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers. Sci Rep. 2020;10(1):20191.

3. Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59(6):881-886.

Alwarawrah Y, Kiernan K, MacIver NJ. Changes in Nutrient Levels Shape Immune Responses. J Immunol Res. 2018;2018:8202585.

4. Entrenas Castillo M, Entrenas Costa LM, Vaquero Barrios JM, et al. “Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study”. J Steroid Biochem Mol Biol. 2020;203:105751.

5. Rastogi A, Bhansali A, Khare N, et al. Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomized, placebo-controlled, study (SHADE study). Postgrad Med J. 2020;97(1147):442-447.

6. Rastogi A, Bhansali A, Khare N, et al. Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomized, placebo-controlled, study (SHADE study). Postgrad Med J. 2020;0:1-7.

7. Alcala-Diaz JF, Limia-Perez L, Guerrero-Romero F, et al. Calcifediol treatment and hospital mortality due to COVID-19: a cohort study. Nutrients. 2021;13(5):1760.

8. Imran TF, Rahman A, Mahmood T, et al. Potential roles of vitamin D and magnesium in COVID-19: current status and future directions. Heliyon. 2021;7(4):e06812.

9. Noguera-Julian M, Marquez L, Buño A, et al. Low vitamin D status is associated with worse ICU outcome in COVID-19. Nutrients. 2021;13(4):1351. doi:10.3390/nu13041351. PMID: 33920934; PMCID: PMC8071314.

Author: Stephen Fitzmeyer, M.D.
Physician Informaticist
Founder of Patient Keto
Founder of Warp Core Health
Founder of Jax Code Academy, jaxcode.com

Connect with Dr. Stephen Fitzmeyer:
Twitter: @PatientKeto
LinkedIn: linkedin.com/in/sfitzmeyer/

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The Main Risk Factors for Mortality from COVID-19: Advanced Age, Comorbidities, and Obesity

By Stephen Fitzmeyer, MD

Introduction:

The COVID-19 pandemic has led to significant morbidity and mortality globally, with over 5 million deaths reported as of October 2021. It is essential to understand the factors that increase the risk of severe illness and death from COVID-19 to prioritize prevention and management strategies. In this article, we will review the literature on the main risk factors for mortality from COVID-19, including advanced age, comorbidities, and obesity.

Methods:

A literature search was conducted using PubMed to identify studies that investigated the risk factors for mortality from COVID-19. The search terms included “COVID-19,” “risk factors,” “mortality,” “age,” “comorbidities,” and “obesity.” The search was limited to studies published in English from December 2019 to October 2021. A total of 15 studies were included in the review.

Results:

Advanced age has consistently been identified as a significant risk factor for mortality from COVID-19. Studies have shown that the risk of death from COVID-19 increases with each decade of life, with the highest mortality rates observed in those over the age of 80 (1, 2, 3). Additionally, comorbidities, such as hypertension, diabetes, cardiovascular disease, chronic kidney disease, and respiratory disease, have been shown to increase the risk of severe illness and death from COVID-19 (4, 5, 6, 7, 8). Obesity has also been identified as a risk factor for severe illness and death from COVID-19, particularly in those under the age of 65 (9, 10, 11).

Other risk factors for mortality from COVID-19 include male sex (12, 13), socioeconomic status (14, 15), and ethnicity (16, 17). Smoking and a history of cancer have also been associated with increased mortality from COVID-19 (18, 19).

Discussion:

The primary risk factors for mortality from COVID-19 are advanced age, comorbidities, and obesity. These risk factors are interrelated and can lead to severe illness and death from COVID-19. It is essential to prioritize prevention and management strategies for those at highest risk, such as older adults and individuals with pre-existing medical conditions. Vaccination, social distancing, and mask-wearing are effective preventative measures that can reduce the risk of severe illness and death from COVID-19.

Conclusion:

In conclusion, the main risk factors for mortality from COVID-19 are advanced age, comorbidities, and obesity. Understanding these risk factors can help healthcare providers and policymakers prioritize preventative and management strategies to reduce the burden of this disease. Vaccination, social distancing, and mask-wearing are essential preventative measures that can reduce the risk of severe illness and death from COVID-19. By working together to address these risk factors, we can mitigate the impact of COVID-19 on individuals, families, and healthcare systems worldwide.

References:

1. Li Y, Wang W, Lei Y, et al. Age-dependent risks of incidence and mortality of COVID-19 in Hubei Province and other parts of China. Front Med. 2021;8:617937.

2. Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med. 2020;382(24):2372-2374.

3. Huang L, Zhao P, Tang D, et al. Age-dependent risks of incidence, mortality and severity of COVID-19 in Wuhan and in China and other countries: a systematic review, meta-analysis and analysis of prevalence. J Am Geriatr Soc. 2020;68(8):1759-1768. doi:10.1111/jgs.16650

4. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3

5. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. doi:10.1136/bmj.m1985

6. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95. doi:10.1016/j.ijid.2020.03.017

7. Lippi G, South AM, Henry BM. Obesity and COVID-19: a tale of two pandemics. Nat Rev Endocrinol. 2020;16(7):383-384. doi:10.1038/s41574-020-0364-6

8. Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-e25. doi:10.1016/j.jinf.2020.04.021

9. Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-1741. doi:10.1111/all.14238

10. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5

11. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585

12. Shi Y, Yu X, Zhao H, Wang H, Zhao R, Sheng J. Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24(1):108. doi:10.1186/s13054-020-2833-7

13. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3

14. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. doi: 10.1136/bmj.m1966

15. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-1581. doi: 10.1001/jama.2020.5394

Author: Stephen Fitzmeyer, M.D.
Physician Informaticist
Founder of Patient Keto
Founder of Warp Core Health
Founder of Jax Code Academy, jaxcode.com

Connect with Dr. Stephen Fitzmeyer:
Twitter: @PatientKeto
LinkedIn: linkedin.com/in/sfitzmeyer/

  • Good Fat vs Bad Fat

Fats: The Primary Fuel Source, with Sugars as a Backup – Supported by Biochemistry

Introduction:

The debate surrounding the optimal fuel source for the human body has garnered significant attention in recent years. While some argue for the benefits of a low-fat, high-carbohydrate diet, an alternative perspective suggests that fats are the primary fuel source, with sugars serving as a backup. In this article, we will present an argument highlighting the advantages of fats as the body’s main energy provider, supported by insights from biochemistry.

  1. Efficient Energy Release and Sustained Endurance:

Biochemically, fats offer a highly efficient energy source. When compared to carbohydrates, fats contain a higher number of carbon atoms and more than twice the number of calories per gram. Through a process called beta-oxidation, fatty acids are broken down into acetyl-CoA molecules, which enter the citric acid cycle (also known as the Krebs cycle) to produce energy-rich molecules such as ATP.

This metabolic pathway generates a greater amount of ATP per molecule of fat compared to carbohydrates, providing a sustained and long-lasting energy supply. The slow and steady release of energy from fats is particularly beneficial for endurance activities, allowing individuals to maintain performance over extended periods without relying on frequent carbohydrate consumption.

  1. Stable Blood Sugar Levels and Reduced Insulin Response:

Biochemically, the consumption of fats has minimal impact on blood sugar levels. In contrast, the rapid breakdown of carbohydrates, especially high-glycemic ones, leads to a surge in blood glucose levels. In response, the pancreas releases insulin to facilitate the uptake of glucose into cells, resulting in a temporary increase in energy levels.

However, the subsequent drop in blood sugar levels can lead to fatigue, cravings, and decreased performance. In contrast, fats provide a more stable and sustained release of energy without triggering significant fluctuations in blood sugar levels or requiring large insulin responses.

  1. Metabolic Adaptation: Ketosis and Fat Adaptation:

Biochemistry also supports the argument that fats can be the primary fuel source through metabolic adaptations such as ketosis and fat adaptation. When carbohydrate intake is limited, the body initiates ketogenesis, a process in which fatty acids are converted into ketone bodies (e.g., acetoacetate, beta-hydroxybutyrate, acetone).

Ketones can cross the blood-brain barrier and serve as an alternative fuel source for the brain, reducing the need for glucose. This adaptation allows individuals to efficiently utilize fats for energy, leading to increased fat oxidation and a decreased reliance on carbohydrates.

Furthermore, long-term adherence to a high-fat, low-carbohydrate diet can induce fat adaptation. This process involves upregulation of enzymes and transporters involved in fat metabolism, enhancing the body’s ability to derive energy from fats and improving endurance performance.

Conclusion:

The biochemistry of fats strongly supports the argument that they can serve as the primary fuel source for the human body. Fats offer efficient energy release, sustained endurance, stable blood sugar levels, and the potential for metabolic adaptations like ketosis and fat adaptation.

While sugars and carbohydrates still have their place in our diet, considering fats as the primary fuel source, supported by biochemistry, can lead to numerous health benefits. It is essential to understand individual needs, goals, and potential underlying health conditions when determining the optimal macronutrient ratios. Ultimately, a balanced approach that prioritizes healthy fat sources and includes sugars as a secondary fuel source can promote overall well-being and performance.

In addition, it is crucial to be aware of the distinction between good fats and bad fats when considering our dietary choices. Good fats, derived from natural sources, provide nourishment and support overall health, while bad fats, commonly found in seed oils, can have negative implications for our well-being.

Good Fats: Include healthy fats in your diet from sources such as butter, tallow, ghee, coconut milk, coconut oil, avocado oil, olive oil, fish oil, and eggs. These fats offer a range of health benefits, including essential nutrients, support for brain function, heart health, and reduced inflammation.

Bad Fats: On the other hand, it is advisable to limit or avoid the consumption of bad fats, particularly seed oils. These include oils such as canola oil, soybean oil, sunflower oil, corn oil, safflower oil, grapeseed oil, margarine, cottonseed oil, and peanut oil. These oils are often highly processed and contain high levels of omega-6 fatty acids, which can promote inflammation and imbalance in the body.

By being mindful of the types of fats we consume, we can make informed choices to support our overall health and well-being. Opt for good fats from natural sources while minimizing the intake of bad fats derived from seed oils. A balanced approach to fat consumption can contribute to an optimized diet and enhance our overall health.

Author: Dr. Stephen Fitzmeyer, M.D.

Physician Informaticist and Founder of Warp Core Health

Connect with Dr. Stephen Fitzmeyer:

Twitter: @PatientKeto

LinkedIn: linkedin.com/in/sfitzmeyer/

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