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Severe COVID-19 Infections: The Role of Diet & Lifestyle

Metabolic Syndrome1 is a cluster of conditions that occur together, increasing risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. The more of these conditions, the greater the risk of complications, such as type 2 diabetes and heart disease. It has been noticed that a large proportion of patients with severe COVID-19 infections have metabolic syndrome. We know that this condition causes inflammation, and that inflammation is a major problem in patients with severe COVID-19 infection2. A study in China found that Diabetic patients had a mortality of 7.8% compared to 2.7% for those without Diabetes, good control of Diabetes lessens but does not remove the extra risk. A study in New York found that obesity was the second strongest predictor of who will require critical care for COVID-19, after age3.

Metabolic Syndrome is linked to a condition called insulin resistance. In this condition cells do not respond normally to insulin and glucose cannot enter the cells as easily. As a result, blood sugar levels rise even as the body produces more and more insulin to try to lower the blood sugar. We all become more insulin resistant as we age but aggressive lifestyle changes can delay or even prevent the development of serious health problems associated with Metabolic Syndrome4.

We know that a healthy lifestyle, maintaining a healthy weight and exercise improve all parameters of health. It would hardly be surprising if this also decreases the chance of having severe COVID-19 infection, particularly if it reverses Metabolic Syndrome and its complications. What is known is that we do not all age at the same rate. When Shakespeare described old age as “sans anything” life expectancy was less than 40 years. Recently, average life span has increased to more than 80 years in many societies. However, ageing is uneven within those societies, we see this every day. A 70 year old may be skiing with their children whilst a 50 year old may effectively be an invalid. Fortunately it is possible to slow or reverse the biological clock, this requires lifestyle changes. A recent Financial Times article stated:

How might we arm our populations against this virus, and for the future? We must turbocharge public health programmes that can reverse chronic conditions such as type-2 diabetes. We should realise that lockdowns which prevent people from exercising will store up trouble. And not bracket people simply by age.

There is much more to learn about COVID-19. But it seems clear that poverty, obesity and its related diseases make some people old before their time.

So what is the best way to go about lowering body weight and blood sugar? There has been a lot of interest on social media in using the keto diet5,6, even for COVID-19, but this is controversial7. Opinion seems to be splitting in to two camps, those who promote a traditional low fat and low calorie approach to weight loss and those who promote a ketogenic/keto diet. For sure the best approach is a diet that works for an individual, for instance keto would be very hard for a vegetarian but much easier for a meat lover. We do know that ketogenic diets can cause sustained weight loss and lowering of blood sugar, inflammation and other risk factors for future ill-health.

As far as exercise is concerned a combination of weight training and cardio works best. For sustainability the exercise should be enjoyable, which is again dependent on the individual, one person may love the gym and another the outdoors. What we can say is that in Hong Kong there are abundant easily available resources for hiking, running and alfresco swimming.

If you already have any of the risk factors for severe COVID-19 consider a plan to reverse the disease process, even if you are on treatment such as sugar lowering or blood pressure medicines. Good control of the risk factors will lower risk of severe COVID-19 but not remove the risk. Better to set about reversing the disease process. Consult a healthcare professional and choose a lifestyle plan to set back your biological clock.


1, 3.  Richardson, S. (2020, April 22). Clinical Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in the NYC Area. Retrieved from

2. Bornstein, S. R., Dalan, R., Hopkins, D., Mingrone, G., & Boehm, B. O. (2020, April 2). Endocrine and metabolic link to coronavirus infection. Retrieved from

4. Metabolic syndrome. (2019, March 14). Retrieved from

5. Volek, J. S., & Feinman, R. D. (2005, November 16). Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Retrieved from

6. Gershuni, V. M., Yan, S. L., & Medici, V. (2018, September). Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Retrieved from

7. Knibbs, J. (2020, March 17). Coronavirus: Health experts warn to stay away from this diet - 'it will not protect you'. Retrieved from

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Topics: COVID-19

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