Category Archives: congestive heart failure

Insulin Resistance, the silent killer and root cause of modern chronic disease.

Insulin is much more than a blood sugar hormone. Produced by the pancreas primarily in response to carbohydrate and sugar consumption, insulin is a master anabolic signal that dictates how every cell in your body grows, uses energy, and repairs itself. When insulin levels are healthy, it keeps the body in a state of “build and store.” When insulin resistance (IR) develops, the body loses its ability to hear this signal, leading to systemic breakdown. Instead of “build and store” the body deteriorates, causing loss of muscle mass, strength, energy production, memory and cognitive function, bone strength, brain cells and connections, ability of blood vessels to relax, ability for the heart to pump blood, ability to achieve restorative sleep, ability of the liver and kidneys to clear toxins from the body, even the ability to reproduce resulting in infertility and erectile dysfunction. Visceral fat stores increase to destructive levels resulting in obesity and obesity-related complications including chronic inflammation which further drives IR to higher levels.

IR is a root cause of cardiovascular disease (heart attack, stroke, hypertension, heart failure), many kinds of cancer (directly linked to breast, prostate and colon cancer), kidney failure, heart failure, dementia, osteoporosis, osteoarthritis, and much more. IR is causally linked or a contributor to, every chronic non-communicable disease of modern civilization.

WHAT IS INSULIN RESISTANCE?

Insulin resistance is the inability of cells and organs to respond normally to insulin signaling. Every cell of every organ has insulin receptors that initiate action by the cell and organ.

WHAT CAUSES INSULIN RESISTANCE?

There are many causes of IR. Stress hormones (cortisol, adrenaline), inflammation, and high insulin levels themselves (response to dietary sugar and refined carbohydrates), each alone and in combination, cause immediate (within minutes to hours) insulin resistance. When these conditions persist over time insulin resistance becomes a chronic state. As fat cells grow in size, they reach a point where there is inadequate blood flow to the cells themselves and macrophages (immune cells that reside between the fat cells, most prominently in visceral fat) produce inflammatory chemicals called cytokines. Cytokines flow through the blood stream and effect every organ and every cell in the body creating a state of chronic inflammation which further worsens IR, creating a vicious cycle. As IR continues the pancreas produces increasingly higher amounts of insulin to maintain normal blood sugar levels but eventually IR becomes so great that blood sugar levels move into the “pre-diabetes” and eventually the diabetes range. IR builds for years to decades before blood sugar regulation fails. By the time blood sugar levels are “abnormal” insulin resistance has done great damage throughout the body.

Most doctors tragically do not order fasting insulin levels as routine blood tests. Fasting insulin levels rise long before fasting blood sugars and hemoglobin A1c start to rise. Meanwhile the damage progresses under the radar of routine testing.

1. Metabolic Engines: Muscle and Liver

Muscle

Normal Action: Insulin acts as a key that opens “doors” (GLUT4 receptors) to let glucose in for fuel. it also stimulates protein synthesis. Protein synthesis is essential to maintaining and increasing muscle mass and strength.
Insulin Resistance Effect: The “doors” stay locked. Glucose stays in the blood, and the muscle becomes “starched,” leading to sarcopenia (muscle wasting) and fatigue. The muscle can no longer utilize dietary protein to maintain or increase muscle mass.

Liver

Normal Action: Tells the liver to stop producing glucose and start storing it as glycogen or converting excess into fat.
Insulin Resistance Effect: The liver ignores the “stop” signal and keeps pumping out glucose while simultaneously ramping up fat production. This results in Non-Alcoholic Fatty Liver Disease (NAFLD).

2. Fat Cells (Adipose Tissue)

Visceral (Deep Fat) vs. Subcutaneous (Under Skin)

Normal Action: Insulin promotes fat storage and inhibits the breakdown of stored fat (lipolysis).
Insulin Resistance Effect: Fat cells—especially visceral ones—become “leaky.” They spill free fatty acids into the bloodstream and release inflammatory cytokines. This causes weight gain that is biologically difficult to lose because high insulin levels keep the “fat-burning” switch permanently off.

3. The Vital Organs: Heart, Kidneys, and Arteries

Heart and Arteries

Normal Action: Insulin stimulates the release of nitric oxide, which helps arteries relax and dilate.
Insulin Resistance Effect: Nitric oxide production drops, causing arteries to stiffen (hypertension). High insulin also damages the endothelial lining, leading to atherosclerosis (plaque buildup). This is the primary driver of heart failure, heart attacks and strokes.

Kidneys

Normal Action: Helps regulate sodium reabsorption.
Insulin Resistance Effect: The kidneys hold onto too much salt, increasing blood pressure. Over time, high blood sugar and inflammation damage the filtering units, leading to chronic kidney disease (CKD).

4. The Brain, Memory, and Sleep

Brain and Memory

Normal Action: Insulin crosses the blood-brain barrier to regulate appetite and support synaptic plasticity (the basis of learning).
Insulin Resistance Effect: Often called “Type 3 Diabetes,” brain IR starves neurons of energy and allows amyloid plaques and neurofibrillary tangles to build up. Worse, the brain is unable to utilize glucose to meet energy demands it starts to malfunction. This is a direct pathway to Alzheimer’s disease and dementia. As the small arteries in the brain become atherosclerotic and unable to deliver adequate oxygen and nourishment to brain cells small areas of the brain become permanently damaged eventually leading to vascular dementia.

Sleep

Insulin Resistance Effect: IR is heavily linked to Obstructive Sleep Apnea. (OSA) High insulin affects the central respiratory drive and increases fat deposits around the neck (a major contributor to obstructive sleep apnea), disrupting sleep cycles and creating periods of inadequate oxygen flow to the brain resulting in the acute stress response and awakening with each apneic event. Even without OSA, high insulin levels impair the production of melatonin which is essential to normal-restorative sleep. Throughout the day the brain accumulates metabolic toxins that must be cleared through the glymphatic system at night during sleep. As sleep is impaired this clearance system is disrupted, contributing to structural damage and functional loss. Sleep disruption and apneic episodes are stressful events, increasing stress hormones which then worsen IR, creating another vicious cycle. One night of sleep disruption causes acute IR. Chronic sleep disruption contributes to chronic IR.

5. Immunity and Structural Health

Immune System

Action: High insulin/glucose impairs white blood cell function.
Effect: Chronic inflammation (high CRP levels) and a weakened defense against infections. This is why diabetics often have poor wound healing. As normal immune regulation is impaired the immune system both over-reacts and under-reacts. Under-reaction increases risk of infection. Over-reaction produces cytokine storms seen with Covid-19 and other infections. Chronic inflammation worsens IR creating another vicious cycle. Chronic inflammation contributes to most chronic diseases.

Bone and Joints

Action: Insulin is bone-building.
Effect: IR leads to poor bone quality (despite high density) and osteoarthritis due to systemic inflammation and the “glycosylation” (sugar-coating) of joint cartilage, making it brittle.

6. The Pancreas: Beta and Alpha Cells

Normal Action: Beta cells produce insulin; Alpha cells produce glucagon (which raises sugar). They balance each other.
Insulin Resistance Effect:
- Beta Cells: Work overtime to produce massive amounts of insulin to compensate, eventually “burning out” and dying. This can produce per4manent irreversible damage to the pancreas.
- Alpha Cells: Become resistant to insulin’s “stop” signal and keep secreting glucagon, further raising blood sugar levels which in turn cause higher insulin secretion, both of which worsen IR, creating another vicious cycle.

7. Reproductive Effects: Infertility

In Women: High insulin stimulates the ovaries to produce excess testosterone, which is the primary driver of Polycystic Ovary Syndrome (PCOS) and infertility.
In Men: IR is a leading cause of low testosterone and erectile dysfunction (due to the arterial damage mentioned above).

Summary of Systemic Effects

Condition	Primary Mechanism of Insulin Resistance
Atherosclerosis	Endothelial dysfunction, high triglycerides, low HDL, increased TG/HDL ratio, increased small dense LDL and remnant particles, increased endothelial permeability.
Dementia	Neuronal glucose starvation and plaque buildup, brain small vessel disease, disruption of blood brain barrier.
Chronic Inflammation	Release of cytokines from visceral fat.
Heart Failure	Stiffening of the heart muscle and high blood pressure.
Diabetes	Pancreatic beta cell and alpha cell damage

Insulin’s Role vs. Insulin Resistance (IR)

Organ/System	Normal Insulin Action	Effects of Insulin Resistance
Liver	Stops glucose production; stores glucose as glycogen.	The liver ignores the “stop” signal, pumping out sugar even when you haven’t eaten (fatty liver).Fatty liver disease is the greatest cause of liver failure in the US.
Muscle	Primary site for glucose uptake; promotes protein synthesis.	Muscles can’t take in fuel efficiently, leading to fatigue and muscle wasting (sarcopenia). Muscle cells cannot use amino acids from dietary protein to maintain or build muscle. Elderly lose muscle and strength, resulting in falls, fractures and head trauma. Loss of muscle (the major sink for blood sugar after a meal) further increases duration and degree of blood sugar and insulin rise after a meal, which in turn increases IR. (vicious cycle)
Fat (Adipose)	Stores fat; inhibits the breakdown of stored fat.	Fat cells leak fatty acids into the blood, leading to high triglycerides and visceral fat gain. Macrophages (immune cells) produce inflammatory cytokines which circulate through the body contributing to chronic inflammation which worsens IR, another vicious cycle.
Brain	Regulates appetite, memory, and cognitive function.	Linked to “Type 3 Diabetes”; impaired memory and increased risk of neurodegeneration. Brain loses ability to meet energy demands and clear toxins. Insulin resistance in the brain explains memory loss, cognitive impairment, loss of neurons and synapses, loss of neuroplasticity. BDNF (brain derived neurotrophic factor) production is decreased by IR.
Arteries	Stimulates nitric oxide for vasodilation (keeps vessels flexible).	Reduced nitric oxide causes vessels to stiffen, raising blood pressure and plaque buildup. This is called endothelial dysfunction, the precursor to heart attack, stroke, peripheral vascular disease and a root cause for neuropathy and amputations.
Heart	Regulates fuel use (switching between glucose and fats).	The heart becomes “metabolically inflexible,” increasing the risk of heart failure.
Kidney	Manages sodium reabsorption and filtration.	High insulin causes the kidneys to hold onto salt, driving up blood pressure and damaging filters. Oxidative stress leads to kidney failure.
Immune System	Modulates inflammation and helps T-cell function.	Creates a state of “chronic low-grade inflammation” and weakens the response to infections.
Bone	Stimulates bone-forming cells (osteoblasts).	Bone quality decreases; despite higher bone density in some cases, the bones are more brittle.
Joints	Maintains cartilage and reduces systemic inflammation.	High insulin promotes pro-inflammatory cytokines, accelerating osteoarthritis and gout.

A meal with sugar and refined carbohydrates causes excessive swings in blood sugar and insulin levels, creating insulin resistance and downstream damage. Alcohol consumption contributes to this process. Fat consumption does not cause a rise in blood sugar or insulin levels. Protein consumption produces a minimal rise in insulin levels in the absence of IR.

Fat storage can occur through hyperplasia (increase in number of fat cells) or hypertrophy (increase in size). Some ethnic groups are more prone to hypertrophy (south and east Asian). Hypertrophy in visceral fat (fat around the internal organs as opposed to fat under the skin) results in macrophage production of inflammatory cytokines. Eventually, the fat cells themselves can literally burst from too much volume.

In my next post, I will discuss what we can do to prevent and reverse IR.

REFERENCES

Chadt A, Al-Hasani H. Glucose transporters in adipose tissue, liver, and skeletal muscle in metabolic health and disease. Pflugers Arch. 2020 Sep;472(9):1273-1298. doi: 10.1007/s00424-020-02417-x. Epub 2020 Jun 26. PMID: 32591906; PMCID: PMC7462924.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7462924/

Fujita S, Rasmussen BB, Cadenas JG, Grady JJ, Volpi E. Effect of insulin on human skeletal muscle protein synthesis is modulated by insulin-induced changes in muscle blood flow and amino acid availability. Am J Physiol Endocrinol Metab. 2006 Oct;291(4):E745-54. doi: 10.1152/ajpendo.00271.2005. Epub 2006 May 16. PMID: 16705054; PMCID: PMC2804964.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2804964

Vargas E, Joy NV, Carrillo Sepulveda MA. Biochemistry, Insulin Metabolic Effects. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525983/

https://www.ncbi.nlm.nih.gov/books/NBK525983/

Bugianesi E, Moscatiello S, Ciaravella MF, Marchesini G. Insulin resistance in nonalcoholic fatty liver disease. Curr Pharm Des. 2010 Jun;16(17):1941-51. doi: 10.2174/138161210791208875. PMID: 20370677.

https://pubmed.ncbi.nlm.nih.gov/20370677/

Cardillo C, Nambi SS, Kilcoyne CM, Choucair WK, Katz A, Quon MJ, Panza JA. Insulin stimulates both endothelin and nitric oxide activity in the human forearm. Circulation. 1999 Aug 24;100(8):820-5. doi: 10.1161/01.cir.100.8.820. PMID: 10458717.

https://pubmed.ncbi.nlm.nih.gov/10458717/

Ke JF, Wang JW, Zhang ZH, Chen MY, Lu JX, Li LX. Insulin Therapy Is Associated With an Increased Risk of Carotid Plaque in Type 2 Diabetes: A Real-World Study. Front Cardiovasc Med. 2021 Feb 1;8:599545. doi: 10.3389/fcvm.2021.599545. PMID: 33598483; PMCID: PMC7882504.

https://pubmed.ncbi.nlm.nih.gov/33598483/

Brosolo G, Da Porto A, Bulfone L, Vacca A, Bertin N, Scandolin L, Catena C, Sechi LA. Insulin Resistance and High Blood Pressure: Mechanistic Insight on the Role of the Kidney. Biomedicines. 2022 Sep 23;10(10):2374. doi: 10.3390/biomedicines10102374. PMID: 36289636; PMCID: PMC9598512.

https://pubmed.ncbi.nlm.nih.gov/36289636/

Kumar M, Dev S, Khalid MU, Siddenthi SM, Noman M, John C, Akubuiro C, Haider A, Rani R, Kashif M, Varrassi G, Khatri M, Kumar S, Mohamad T. The Bidirectional Link Between Diabetes and Kidney Disease: Mechanisms and Management. Cureus. 2023 Sep 20;15(9):e45615. doi: 10.7759/cureus.45615. PMID: 37868469; PMCID: PMC10588295.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10588295/

Banks WA, Owen JB, Erickson MA. Insulin in the brain: there and back again. Pharmacol Ther. 2012 Oct;136(1):82-93. doi: 10.1016/j.pharmthera.2012.07.006. Epub 2012 Jul 17. PMID: 22820012; PMCID: PMC4134675.

https://pubmed.ncbi.nlm.nih.gov/22820012/

Rahman MS, Hossain KS, Das S, Kundu S, Adegoke EO, Rahman MA, Hannan MA, Uddin MJ, Pang MG. Role of Insulin in Health and Disease: An Update. Int J Mol Sci. 2021 Jun 15;22(12):6403. doi: 10.3390/ijms22126403. PMID: 34203830; PMCID: PMC8232639.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8232639/

Scherrer U, Sartori C. Insulin as a vascular and sympathoexcitatory hormone: implications for blood pressure regulation, insulin sensitivity, and cardiovascular morbidity. Circulation. 1997 Dec 2;96(11):4104-13. doi: 10.1161/01.cir.96.11.4104. PMID: 9403636.

https://pubmed.ncbi.nlm.nih.gov/9403636/

Affuso F, Micillo F, Fazio S. Insulin Resistance, a Risk Factor for Alzheimer’s Disease: Pathological Mechanisms and a New Proposal for a Preventive Therapeutic Approach. Biomedicines. 2024 Aug 19;12(8):1888. doi: 10.3390/biomedicines12081888. PMID: 39200352; PMCID: PMC11351221.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11351221/

Park MH, Kim DH, Lee EK, Kim ND, Im DS, Lee J, Yu BP, Chung HY. Age-related inflammation and insulin resistance: a review of their intricate interdependency. Arch Pharm Res. 2014 Dec;37(12):1507-14. doi: 10.1007/s12272-014-0474-6. Epub 2014 Sep 20. PMID: 25239110; PMCID: PMC4246128.

https://pubmed.ncbi.nlm.nih.gov/25239110/

Hardy OT, Czech MP, Corvera S. What causes the insulin resistance underlying obesity? Curr Opin Endocrinol Diabetes Obes. 2012 Apr;19(2):81-7. doi: 10.1097/MED.0b013e3283514e13. PMID: 22327367; PMCID: PMC4038351.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4038351/

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

4th International Evolutionary Health Conference

COVID-19 and Death Certificates, Trumps Allegations

1 Reply

Trump has recently accused doctors of falsifying death certificates for financial gain. Let’s be clear.

If a patient is hospitalized with viral pneumonia and dies, the cause of death has ALWAYS been listed as the viral pneumonia, no matter what complications occurred, no matter what the pre-existing conditions were. Viral pneumonia can cause heart attack, stroke, kidney failure, multiple organ failure but the proper cause of death to be listed is the initial presenting causative agent.
Doctor’s caring for COVID-19 patients in the hospital do not get paid more because of the diagnosis. Hospitals may get extra payment because of the pandemic circumstances, doctors do not. Recently the AMA has recommended additional payment to OFFICE PRACTICES for the extra expense of COVID-19 precautions. This does not impact hospital doctor payment.
Death is not the only bad outcome. “Long COVID” is a state of persistent symptoms and disability that can occur even after mild illness not requiring hospitalization. Post viral syndromes such as this have long been recognized and can last a lifetime. Consequences can include shortness of breath with minimal exertion, chronic fatigue, heart failure, kidney failure, chronic pain to name a few. A recent study from Germany demonstrated MYOCARDITIS (chronic heart inflammation) in 70% of patients “recovered” from COVID-19. 80% of those patients were not hospitalized. We do not yet know the extent of long term morbidity caused by this virus. Viral Myocarditis is a common cause of cardiomyopathy that can lead to heart transplant, shortened life, and decreased quality of life.
Misleading and untruthful statements that downplay the serious nature of this pandemic, especially by national leadership, cause great harm to our nation, bringing unnecessary death, suffering, and economic ruin. Such lies result in many people defying necessary and effective public health measures such as wearing masks, washing hands, social distancing.
In any pandemic public health recommendations change as more information becomes available. This is to be expected. Trump has dangerously and tragically criticized our public health leaders for changing recommendations as new information and new circumstances have evolved.
The greatest nation in the world still has not implemented an adequate TEST-TRACE-ISOLATE infrastructure. Our testing is inadequate, takes too long, has too many false positives and false negatives. Similarly, tracing and isolating are not widely and effectively implemented. This requires NATIONAL COORDINATION AND LEADERSHIP. It also requires that all Americans take this seriously. Trumps denial of the truth has led many Americans to disregard the necessary steps to safely reopen our economy.
By now business shut downs and severe restrictions would be unnecessary if America had instituted early and effective TEST-TRACE-ISOLATE. By now, our economy would be out of trouble. Instead lies, deceit, and incompetence has led to unnecessary death, suffering, chronic illness, and economic disaster.
Even after a vaccine is available, MASKS, HAND WASHING, SOCIAL DISTANCE, will still be necessary for a long time.

The Republican leadership has consistently failed to call out TRUMP on this issue and many others. The Republican leaders have failed to fulfill their sworn duty to protect our citizens from harm and instead placed party over country. This deplorable behavior threatens Balance of Power and Democracy itself.

In the context of the COVID 19 pandemic I will close with the usual summary.

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels.
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

COVID 19: Masks and Distance not enough, where we have faltered and failed

1 Reply

Test
Trace
Isolate

That is where we have failed. Those countries that rapidly instituted masks, social distance, frequent hand washing, PLUS Test/Trace/Isolate succeeded in limiting the speed of spread, protected the Medical Care (hospital) system from being over-run, and protected it’s citizens and economy. Those countries bought time to learn enough about the virus to lower the mortality rates by developing treatments that decrease risk of death AND probably disability and to ramp up the hospital care system and PPE.

The US has failed to meet the challenge.

Death may not be the worst outcome, depending on one’s views relative to the balance between longevity and quality of life. Chronic disability (such as congestive heart failure, severe pulmonary insufficiency, kidney failure requiring dialysis, stroke, etc.) can be lifelong and devastating following this infection. Some may consider that shortness of breath after walking 100 feet, requiring a rest before moving on, or kidney dialysis 3 times per week the price one must pay to survive a serious infection. Others may think this sort of severe disability is not acceptable. Many in our society are clueless about these potential outcomes (usually that means they are in denial, a very common defense mechanism used to deal with a terrible threat).

This did not have to be our present state, but it is.

In December US intelligence agencies (including the CIA) and the US military intelligence were already issuing reports about an emerging deadly respiratory virus in China. This went up the chain of command but was ignored by the Whitehouse. In January, Doctor Fauci, at the annual BIOTHREATS CONFERENCE in Washington DC, announced to the bio-tech industry representatives in attendance that this virus was already “beyond containment” and stated that aggressive biomedical development (drugs, vaccines, etc.) would be required. He told attendees that the NIH would “find the money” to support these efforts and that this was a national and global emergency.

Undoubtedly, this was reported to the Whitehouse. These early warnings were not only ignored, they were also widely denied publicly by our highest public official. (The warnings issued in senatorial and congressional committee meetings however, prompted many privileged senators and congress people to sell pandemic-sensitive stocks very early in the “denial phase”).

It is clear that masks and social distancing are effective in limiting spread. Super-spreader cases, case studies of spread in restaurants (China) , call centers (South Korea), and choir rehearsals (Washington State) suggest that both droplet and aerosol transmission occur in non-medical procedure settings.

We already knew that aerosol spread occurred in operating rooms when nasopharyngeal surgery and similar aerosol generating medical procedures were performed. In one operating room event, all 11 doctors and nurses who spent any amount of time in that operating room (despite everyone wearing N95 masks) became infected and the surgeon died from the infection (he had the most exposure). This was reported early on documenting aerosol spread in medical settings.

For those who have not read my previous discussion of aerosol vs droplet spread:

Aerosol = very small lighter-than-air particles containing infectious virus that float in the air and can be recirculated through air-conditioning vents or linger suspended in the air, especially indoors where the air is still.

Droplets = larger particles that fall quickly onto surfaces but can also with a cough, sneeze, scream or singing be transmitted to someone in very close proximity before falling .

Then we learned that carriers/transmitters of the virus can either remain completely without symptoms or develop symptoms as late as 10 days after initial exposure, all the while transmitting the virus to others around them. Assymptomatic transmission makes COVID 19 different from and more dangerous than most other viruses that infect humans.

Let me say that again.

Aerosol transmission makes this virus more dangerous than most other viruses.

Asymptomatic transmission makes this virus more dangerous than most other viruses.

And finally we have learned that this virus is more lethal than most other viruses. For example, COVID 19 is 25 times more lethal than the H1N1 influenza pandemic (references provided in previous post).

https://practical-evolutionary-health.com/2020/07/12/covid-19-update-what-have-we-learned/

To summarize, the combination of easy transmission, asymptomatic transmission, and high mortality rate make this virus exceptionally dangerous and difficult to control.

How did the US respond?

Instead of rapidly ramping up PPE, testing, tracing, and isolation public health capability we instead had national leadership that said this was just like “another flu” virus and would “go away”. The narrative constantly shifted, but more importantly, effective action was not taken, and still has not been taken.

Testing remains woefully inadequate.

In many areas of our country it can take 5 days to schedule a test and 10 days to get the results. Such tests are useless. To effectively implement TEST/TRACE/ISOLATE we need rapid and widespread testing, rapid reporting, and a system to then trace contacts and isolate infected and exposed individuals. The US still shamefully lacks these essential services.

John’s Hopkins University early on developed an on-line contact tracing training program. But public funding to hire such trained individuals has been inadequate.

Isolation requires facilities in which exposed or infected individuals have their own bathroom and bedroom, have food provided, and are medically supervised until they are no longer infectious.

The US does not have such facilities. Individuals, unless they are financially very secure, do not have access to a home or other environment where this is possible. Worse, those essential workers (meat packers, food delivery, nursing aids, etc.) who earn the least, usually live in cramped housing conditions with multi-generation households in which isolation is impossible. Such individuals often live from paycheck to paycheck, so staying home from work means the family does not eat or the rent is not paid. So they go to work infecting others.

The result has been not just death and disability but horrible economic consequences.

Our shutdowns could have been shorter had we acted quickly and effectively.

Had we responded rapidly and appropriately, we would not be in our present economic predicament. So ironically and tragically, those that complain that shutdowns “were not necessary” and masks “are not necessary” contribute to the worsening economic consequences. As the virus surges following relaxation of restrictions, further restrictions and economic consequences become necessary.

Compounding this situation is the denial on the part of many individuals regarding the science and facts about this virus. Part of this denial is the result of our con-artist in chief, (and some governors) misrepresenting the facts to the public and displaying inappropriate behavior (such as refusal to wear a mask until most recently).

The other component of this denial is based on the natural tendency of humans to ignore data that is threatening and not consistent with personal ideology and beliefs. Beliefs such as “the government lies, the government is not to be trusted, the government cannot tell me what to do” presents obstacles to social behavior that would protect not just oneself and family, but the community (and economy) in general.

Contact tracers have reported that sometimes people hang up on them, refuse to cooperate, sometimes saying that it is an “invasion of privacy” or a “government hoax”.

Such beliefs and behaviors are encouraged by misinformation in the social media, shock-jocks such as Rush Limbaugh, conspiracy theories, and supported by dangerous politicians who have placed party over country, ideology over science, the next election over the good of the country.

The best way to mitigate the dire health and ECONOMIC CONSEQUENCES of this pandemic include all those components that have worked in other countries:

MASKS4ALL
SOCIAL DISTANCE
FREQUENT HAND WASHING
SOCIAL BUBBLE

TEST/TRACE/ISOLATE

This is a sad state. In the meantime what can you do?

In the context of the COVID 19 pandemic I will close with the usual summary.

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels.
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

COVID-19: ARDS, CYTOKINE STORM, and GLUTATHIONE

2 Replies

My good friend Dr. Deborah Gordon recently sent me a terrific article on an Integrative Medicine Approach to Covid-19. It confirmed much of what I have discussed about COVID-19 and provides 383 scientific references (many of which were cited in my previous posts). Thank you Dr. Deborah!

In my last post I promised to write about glutathione and cytokine storm.

Cytokines are proteins made by our immune system. When our body suffers an infection, cytokines act as essential signaling proteins that produce a defensive inflammatory response. In a cytokine storm the usual regulatory process that helps resolve inflammation becomes disturbed and self destruction can occur.

With COVID-19 this can happen in any organ of the body but frequently starts in the lungs, resulting in ARDS (Acute Respiratory Distress Syndrome).

In most clinical contexts the mortality rate of ARDS is 40-45%. In the context of COVID-19 it is 80-90 % lethal in most clinical reports (twice the usual mortality rate for ARDS). However, the ICU doctors in the Northwell Hospital system in NYC have been using NAC (n-Acetylcysteine).

While using NAC as part of their treatment protocol of COVID-19 associated ARDS, they are getting 50% of patients off the ventilator with a significant reduction in mortality rates compared to previous reports (personal communication with a Northwell physician and also mentioned in the Review Article cited above.)

This drug (also available as a dietary supplement) has been used for decades to treat acetaminophen (APAP) overdose (Tylenol brand name, also called paracetamol in Europe). If not treated early APAP overdose commonly causes death from liver failure.

Chronic acetaminophen toxicity is the most common cause of liver failure leading to liver transplant in the US.

How does this treatment with NAC work in the setting of APAP overdose?

“When paracetamol is taken in large quantities, a minor metabolite called N-acetyl-p-benzoquinone imine (NAPQI) accumulates within the body. It is normally conjugated by glutathione, but when taken in excess, the body’s glutathione reserves are not sufficient to deactivate the toxic NAPQI. This metabolite is then free to react with key hepatic enzymes, thereby damaging liver cells. This may lead to severe liver damage and even death by acute liver failure.”

NAC (n-acetylcysteine) provides cysteine, one of the three amino acids that make up glutathione.

“glutathione synthesis is primarily controlled by the cellular level of the amino acid cysteine, the availability of which is the rate-limiting step.”

So by providing a source of cysteine, the body produces more glutathione which can detoxify the liver damaging metabolites of APAP.

Glutathione is our MASTER ANTI-OXIDANT. Since a cytokine storm involves an overwhelming amount of oxidative stress, glutathione is obviously important.

Clinical research in the 1990s established that the lungs of patients with ARDS are very deficient in glutathione.

A profound 20 fold reduction was confirmed in this study.

“Glutathione is a tripeptide that is able to react with and effectively neutralize oxidants, such as hydrogen peroxide. The present study found that the alveolar epithelial lining fluid of patients with ARDS was deficient in total glutathione compared with that of normal subjects (31.5 ± 8.4 versus 651.0 ± 103.1 µM, p = 0.0001) and patients with cardiogenic pulmonary edema (31.5 ± 8.4 versus 154.1 ± 52.4 µM, p = 0.001). In addition, a greater percentage of total glutathione was in the oxidized form in patients with ARDS compared with normal subjects (30.6 ± 6.1 versus 6.4 ± 2.9%, p = 0.03). This deficiency of reduced glutathione in the alveolar fluid may predispose these patients to enhanced lung cell injury.

Subsequent studies of humans with ARDS on ventilators showed clinical benefit by increasing glutathione levels with NAC.

“In our controlled clinical trials with NAC we found that patients with ARDS have depressed plasma and red cell glutathione concentrations, that these levels are substantially increased by therapy with intravenous NAC and there are measurable clinical responses to treatment with regard to increased oxygen delivery, improved lung compliance and resolution of pulmonary edema.”

Despite these findings decades ago, the use of NAC for ARDS has not been widely adopted. But it would make sense to employ this inexpensive medication, widely used for APAP overdose, for ARDS and in particular for cytokine storm caused by COVID-19.

Oxidative stress decreases glutathione levels and if these levels reach a critically low level in tissues, organ damage can ensue rapidly. Cytokine storm is the extreme example.

Chronic alcohol abuse also decreases protective glutathione levels in the lung.

In my recent posts on COVID-19 I have pointed out that alcohol (even 2 drinks) suppresses the immune system for at least a few days. Alcohol consumption is a double hit, first as an immune suppressant, then as a major source of oxidative stress and reduction in protective glutathione levels. Two glasses of wine tonight followed by a COVID-19 sneeze in your face the next day could be the difference between an effective immune response (mild symptoms) versus an overwhelming life threatening infection!

Likewise, one night of inadequate sleep (which immediately suppresses immunity) followed by a COVID sneeze in your face the next day could have the same deleterious effect.

Below is a chart from the review article mentioned at the start of this post. Notice the top line states “ADDRESS SLEEP, STRESS, DIET, SUGAR, ALCOHOL”

If you have been reading my posts on COVID-19, you have heard this before.

integrative medicine chart

Notice the second row in the chart with escalating doses of NAC as intensity of disease increases. When cytokine storm hits NAC dose recommendations peak and glutathione (available for IV administration) is recommended. IV glutathione surprisingly is not part of most hospital formularies and I have never seen it used in a hospital setting. Functional medicine physicians sometimes use it outside of the hospital setting. IV glutathione has become a sexy and lucrative office procedure in some functional medicine practices.

NAC has high bioavailability, meaning it is absorbed well in our gut. So oral supplementation can rapidly and effectively increase levels of glutathione in the body. IN FACT, treatment of acetaminophen overdose in the ER typically begins with oral NAC (often administered through a naso-gastric feeding tube, passed through the nose and into the stomach) Doses are often calculated by the regional poison control center (available by phone 24/7/365) and subsequent doses follow a standard protocol based on weight.

I would encourage you to read through this COVID-19 INTEGRATIVE MEDICINE review article.

It is thick with science but you might be surprised by how much you understand and learn.

In the chart above there is specific mention of Vitamin C supplementation in escalating doses as degree of illness increases. Vitamin C is an important anti-oxidant and in that sense is a glutathione sparing agent helping to mitigate glutathione depletion.

Other important factors mentioned in the article and the chart above include items mentioned here in previous posts: ZINC, ZINC IONOPHORES, phytochemicals (quercitin, EGCg, curcumin), Vitamin D, exercise, sleep, stress reduction, sunshine.

So I will close this post the way I have closed on many posts related to COVID-19.

Support your immune system.

In the context of the COVID 19 pandemic I will close with the usual summary.

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
Drink water filtered through a high quality system that eliminates most environmental toxins.
HEPA filters or the home-made version (Corsi-Rosenthal box) used in your home or workplace can reduce circulating viral load by 80%. This works for any respiratory virus transmitted by aerosol and this winter we have the triple threat of RSV, Influenza, and SARS-CoV-2. It also decreases indoor air pollution.
If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

Glutathione review links are below:

Glutathione!

Mitochondrial Glutathione, a key survival antioxidant

Glutathione: overview of its protective roles, measurement, and biosynthesis

Paleolithic Diet Reversed Osteoporosis and Fatty Liver in an 82 year old man

Practical Evolutionary Health

How food, exercise, sleep and stress affect your health, longevity, and happiness. How have we deviated from our evolutionary makeup?

Category Archives: congestive heart failure

Insulin Resistance, the silent killer and root cause of modern chronic disease.

4th International Evolutionary Health Conference

COVID-19 and Death Certificates, Trumps Allegations

COVID 19: Masks and Distance not enough, where we have faltered and failed

COVID-19: ARDS, CYTOKINE STORM, and GLUTATHIONE

Paleolithic Diet Reversed Osteoporosis and Fatty Liver in an 82 year old man

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