It’s very important to have a strong immune system, would you agree with that?
Yes. I think it’s common sense if we’re dealing with an infectious disease that you need to fight with an immune system. You have to understand that we actually have ‘soldiers’ and ‘armies’ in our bodies to fight these viruses and bacteria. A strong immune system is very important. There are things that weaken your immune system. That has played out to be a bad thing with COVID-19, too.
There was a mouse study done at Yale recently – I know that you’re not particularly fond of animal studies – but in this study they found that a ketogenic diet triggered a release of mucus in the cell linings of the lungs which trapped the flu virus. What do you say to studies like that?
That’s very interesting and it might apply to people. I am human-centric, meaning in the keto world, I want studies in people. I’m really cautious about extrapolating animal studies to humans, because there are a lot of steps that could make it not work out that way. Not being an expert in the immune system model they use, it might be that it correlates directly to human experience. I just don’t know. Generally speaking, I think it’s very interesting and when there’s one study, of course you always want the second one to validate it, hopefully by a different group.
I didn’t know that that was a possible mechanism of the mucus. I think more in terms of the immune system, the cells that work to fight infections. So, that’s an intriguing study. It just goes to show that there’s a lot we don’t understand about keto and diets and immunity, and the more we study keto in general, the better it looks, metabolically. Twenty years ago we thought ketosis was bad and that it was ketoacidosis and one would want to stay away – now we call it “nutritional ketosis” and not ketoacidosis.
We know that people with type 2 diabetes, metabolic syndrome, hypertension, and other metabolic related illnesses are at a greater risk of contracting COVID-19. Would I be assuming correctly in saying that if we could reverse these conditions, the COVID-19 risk could be reduced?
The first idea is definitely true. If you pick up a medical journal now, you’re going to find an article about diabetes and obesity being risk factors for worse outcomes for COVID-19. If you have an underlying metabolic problem like that and you get ill and you get in the hospital, you have a higher chance of dying. Before that, you can look at the percentage of people that have COVID-19 and there’s a high rate of obesity and diabetes—more than you would expect from the general population. We think that it puts you at higher risk for getting the disease and then if you do get it you’ll have worse outcomes. Now, you can’t directly conclude that had you not had diabetes and obesity, you’d have better outcomes or you wouldn’t get it, but it’s a strong indicator. First you find correlations. I don’t think that anyone will go back and randomize you to have diabetes and get COVID-19 though! So there’ll never be the randomized experimental trial that you want, but certainly this is making most experts say that you don’t want to have diabetes or metabolic problems like obesity, because it puts you at a higher risk for COVID-19 along with worse outcomes.
Scientifically, we haven’t done the studies to prove that, but the logic of it makes sense. We observe that there are higher rates. I’ve known for a long time that the higher the blood sugar is over the day, the worse the immune system functions; the immune cells don’t function as well. I was taught that if blood sugar is over 200 mg/dL (11.1 mmol/L) all day long, your blood cells don’t work properly—that was the training from years ago. There are findings or changes that occur when the blood sugar is high all day long—that’s called diabetes—and they’re not good. People with diabetes are at higher risk of skin infections, for example, which may lead to amputations. It just makes sense that you would be at higher risk and have worse outcomes with COVID-19 if you have a metabolic disease. Thinking this through, if you’re in quarantine, why not work on your metabolic health? If you’re now working at home, you have more time to devote to preparing food. Now is the time to work on metabolic health. I’ve noticed some people start to look a little more muscular because they’ve gotten a workout machine and they’re taking a year to get on the exercise kick. Why not get on the nutrition kick, the diet kick? Learn about how carbs can be bad for your health. Not everyone needs to do keto, but I think we need to be clear that sugar and sugar in large amounts can elevate the blood sugar and cause diabetes. That’s the “bad guy” of the metabolic health world today. It’s not fat anymore; it’s sugar.
It certainly couldn’t hurt if people found a little bit of extra time to try and implement this. This would be the best time to try and do it.
You actually end up eating less if you have extra energy on your body in the form of fat. This is energy that would keep you alive in a famine! All we do on a low-carb diet is have you not eat sugar, and then, rather than burning sugar, your body starts burning fat. Many people eat less and so if you’re struggling to juggle finances and rent and food, you can actually eat less and fix your metabolic problems and not even pay for medications anymore, just by changing the food and cutting out the carbs! I have people who are spending lots of money on medications and I give them the choice: you don’t need to spend money on medications if you address the food and the lifestyle. So, a lot of people are taking this pause to address their metabolic and physical health.
Merlin asks: “Dr. Westman, I know you’ve done some research into cigarette smoking. Do you think immune health is compromised from smoking even though I’ve been on a keto diet for roughly two years?”
I spent ten years working on research for smoking cessation and nicotine. Definitely, someone who smokes 10 cigarettes a day or more is more likely to get respiratory infections, like chronic bronchitis. I’ve been out of that world a little too long to comment on the latest understanding.
I guess the short answer would be, try to quit smoking.
There’s very little to speak about the benefits of smoking; however, many people use it for stress reduction or they’re just purely addicted to it. I would be hard-pressed to say that there was really any health benefit from smoking.
This guy is smoking on the one hand and doing a keto diet on the other hand. Smoking can’t be any good for your immune system. I would just suggest trying to cut down or stopping smoking altogether.
I’m not an all-or-nothing thinker, even about this, because I know there are studies of giving vitamin C to people who smoke to try to reduce the cancer risk. All-or-nothing thinkers say, “Just get everyone to quit.” Well, the reality is that there still are something like 25 percent of people who smoke and most of them can’t quit unless you outlaw it. It’s a complicated issue, kind of like food. With my patients, I’ll try to help you quit.
Natalie asks: “ I have type 2 diabetes and am overweight. If I start a keto diet now, how long do you think it would take to improve my immune health?”
My understanding is that if the blood sugar—that’s the blood glucose, the A1C hemoglobin is a reflection of it—it all hangs together. If your blood glucose is high, you can have immediate improvement in immune function if you lower the blood glucose. I think the benefits are probably pretty quick. How big that benefit is, I don’t know for sure, but on the first day of doing a keto diet, the blood sugar can come down 50 to 100 points (in the milligram per deciliter system). I’m an optimist in that regard. I think it could help your immune function very quickly to cut out carbohydrates if your blood sugar is very high. In my experience of using a keto diet for weight loss, I see about a pound or two of weight loss per week. That’s 5 to 10 pounds (2 to 5 kg) per month, 50 to 100 pounds (23 to 45 kg) per year, and that will get the immune benefits over that period of time. You have to understand my mindset, my way of thinking: if there’s a possibility that it will help and it will do no harm, why wouldn’t you try it? All you’re doing is eating great food like meat, poultry, fish and eggs. The downside is pretty low.
Barbara asks: “Is there a test to determine immune health?”
Not that I use clinically every day. In fact, the white blood cells in our blood are the ones that fight infection. They do go up if you have an infection, but I don’t think that it’s affected by other factors as well. If someone is sick, you can see a pattern of blood cells change. The white cells and the type of the white cells will change if you’re sick. I don’t think it’s sensitive enough, meaning it won’t give you an indication if you’re not otherwise sick. If you’re healthy and you just want to see how your immune function is, I don’t think that would be a great test of it. There may be some tests you can get at a research facility or specialized laboratory, but I’m not aware of that. I think focusing on the blood glucose, keeping that down and staying away from sugar as much as you can, will go a long way.
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