Understanding the Risk Factors of Obesity and Age for Covid-19.

An ounce of prevention is worth a pound of cure.  An old adage that is very appropriate for the Tibetan Medical approach to any illness and in this case Covid-19.

By balancing our body’s energies or nyes pa and balancing our mind we can bring our whole system into optimum health.  This means we have a strong immune system and the ability to fight off any outside infections.  Covid-19 particularly is hard for those with underlying illness or co-morbidities, such as asthma, cancer, chronic kidney disease, heart conditions, smoking, sickle cell disease and type 2 diabetes mellitus, obesity and COPD (Chronic Obstructive Pulmonary Disease).   Some of these conditions may seem outside of our ability to control but even so we can use this opportunity to take another look at our diet and behavior in order to become as healthy as possible.  

On October 6, 2020 the CDC announced a “Summary of Recent Changes” to reflect recent data supporting increased risk of severe illness from the virus that causes COVID-19 among adults who have obesity, who are overweight, or who smoke or have a history of smoking. The listed underlying medical conditions in children were also revised to indicate that these conditions might increase risk to better reflect the quality of available data currently. 

I found this information interesting and wondered why being overweight or obese might be a risk for more severe illness.  What might be the connection to the fact that the older one gets the higher the risk of severe illness associated with COVID-19?

People with a higher BMI (body mass index) usually have more fat or adipose tissue.  Fat is a way for the body to store energy.  There are different kinds of adipose tissue depending on the location in your body; the fat under our skin  (subcutaneous) and the fat around our organs (visceral). Visceral fat is found in spaces around our heart, liver, our intestines and our belly and is hormone rich and more active.  For anyone who has looked at a piece of meat it is obvious that fat unlike an organ or muscle doesn’t have a lot of blood vessels, it is generally white and muscle meat is blood red.   Since the body still needs to use fat for energy and get nutrients in and out the blood vessels are extra important and need to be very responsive, more so than the blood vessels found in muscle where there are more of them.  ACE2 receptors are blood vessel active proteinaceous gateway involved in circulation.  That is why there are more ACE2 receptors found in fat and in particular in visceral fat around the organs.  Besides being in fat, there are also tons of ACE2 in the lungs, especially the lower lung because they are so vascular rich. ACE2 are part of the biochemical pathway that regulates processes in the body including converting a protein that increases blood pressure and inflammation and in this way ACE2 normally helps to protect the lungs.

It turns out the Covid-19 virus has evolved to attach and cling to ACE2 receptors. when the Covid-19 virus binds with these receptors they can no longer do their job.  Covid-19 gets into the body attaches to and accumulates in ACE2 receptors and interferes with ACE2 normal functions.  From the ACE2 receptors in  visceral fat and lower lungs the virus travels into the blood stream, moving throughout the body.

It makes sense then that people who have more fat tissue have more ACE2 receptors and therefore end up being a bigger attractant to the Covid-19 virus.  We have all probably heard the talk about viral load, this just refers to the amount of virus in the body.  It is now known that obese people (those with a BMI >30) have a higher viral load and that the virus seems to stay longer in their body.  Basically fat is like huge housing for these virus allowing them to just hang out, reproduce and mobilize in the body.  

What does this have to do then with the greater risk of being elderly?  It turns out that we also make more ACE2 receptors as we get older. As we age our systems and organs break down naturally over time.  This is a natural process.  Our body (being such a wonderfully engineered natural system) tries to repair itself to the extent possible.  Our blood vessels become more and more important and with it our ACE2 receptors also ramp up. This means that the older one gets the more ACE2 receptors there are in our body.  Therefore  if we take an otherwise healthy person, all else being equal, the two biggest risk factors are age and the amount of fat in the body.

So now that we have some understanding of why, what can we do about it?  We can’t make ourselves younger but can work on getting ourselves to our optimum health and state of balance.

To begin with it’s important to say that there is no blanket diet or behavior for everyone and having a qualified Menpa (Tibetan Doctor) to consult with can help understand one’s own individual constitution and situation and get dietary and behavioral advice that is geared to one’s own body and mind.

In Tibetan medicine fat (adipose) or tsil is associated with the nyes pa of béken (earth & water). Often, reducing béken is only part of what a person needs.  That being said if one is trying to reduce béken there are some things to know.  Iin order to reduce béken we can avoid sleeping in the daytime which causes béken to increase.  We can eat foods that decrease béken. These are foods which have the last three tastes of bitter, hot, astringent and also have the quality of being ‘rough and light’ such as lentils, roasted grains or grains grown in dry land or meat raised on dry land.  We can avoid greasy, oily, heavy, cool or dull foods and drink hot boiled water and ginger tea.  Moderate exercise every day is also recommended and taking moderate portions of food.  For instance if we think of the stomach as having four compartments, when we have a meal we are advised to fill two parts with food, one part with liquid and leave the last part empty so the food has room to move around and digest. This means that we might leave the table still feeling a bit hungry, or at least not stuffed  but this helps to keep the digestive fire active and metabolism working throughout our body.  These are all basic instructions that anyone might hear in order to lose weight but it may help to think of these recommendations in terms of restoring balance to our body rather than just trying to arrive at a number.  

As far as mitigating the risk of aging of course we can’t turn back the clock but we can do bcud len or rejuvenation practices. This is a traditional Tibetan Medicine practice that can be recommended and guided by a qualified Menpa.   bCud len can be done once a year after we reach age 45 or so and is meant to maintain and boost our digestive heat and increase longevity.   It involves partial fasting, simplified diet, spiritual practice and cleansing the digestive tract followed by herbal supplements to balance the digestive process and ignite digestive fire. Traditionally this practice would mean going to a quiet place and preferably doing a spiritual practice or retreat to cleanse the mind and body before the rejuvenation formulas. 

Today we can also adapt this to our own lives and current situation.  Since many of us are spending more time at home already, it may be easier to create a quiet environment that allows for spiritual reflection and a modified bcud len practice.  Perhaps we can take a bad situation and use it to become healthier in body, mind and spirit.