Quote:
Originally Posted by Titty Meat
Hamas I have a dumb question for you and I debated a friend who's a UCSF med school grade.
If a person who eats healthier and exercises 30 minutes a day are they less likely to die from this virus?
My uneducated thinking on this is 1. Most people who die from this already have underlying conditions which obesity contributes to that 2. The mortality rate is rather low so even if you save a few thousands lives by people getting into better shape you've done your job 3. You are much more likely to atleast incorporate some fruits and vegetables into your diet and walk a few miles a week and lose 15-20 pounds by November then there is for a vaccine to be figured out by then.
I get its simplistic thinking and not a "cure" but I havent seen this mentioned on a national, state or local level. Just seems like something that might help during a time when people are losing their shit. What better motivation?
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It wouldn't hurt; the extent to which it would help over a short period is likely unknowable, but probably very small for the individual while helpful for the population. The thing to remember is that most of our major killers do so slowly. They call hypertension the silent killer because you can do tremendous damage while asymptomatic. You aren't going to begin experiencing angina from clogged coronary arteries until you have significant disease, and many people don't get diagnosed with Type II Diabetes until they have really bad A1c levels.
Hypertension results in end organ damage to the heart, kidneys, and cerebral vasculature, but it's a pretty slow process. Coronary artery disease can be stabilized, and plaques can stabilize and even lessen, but it takes a fair amount of time, and Type II Diabetes wreaks havoc all over the body (the biggest issue is a substantially increased cardiovascular risk).
It might be more helpful to think of it as a continuum of disease rather than an on/off switch. Having no comorbidities is better than having controlled disease states, which are better than uncontrolled disease states. I would hazard a guess that those whose chronic diseases are fairly well-controlled don't have significantly increased mortality risks from COVID.
For example: If I have two consecutive BPs over 140/90, I can be diagnosed as having hypertension. But if I watch my diet (DASH is a good one) and exercise, and I get down to 120/80, I still technically have hypertension, but it's controlled (this is a little more complex with some of the newer guidelines released in 2018, but we'll skip over that). Or, let's say that in addition to diet and exercise, I take a small dose of a thiazide diuretic and that controls my BP. Another person has a BP of 150/100 and they start them on medical management, but it doesn't control it, so they add another drug and that gets them to 120/80. They're controlled but the underlying disease is more severe. The next person has a high BP and is prescribed agents that can control it, but they aren't adherent, so sometimes it's within goal and other times it's far above. And then there's the guy that it is 170/110, has resistant hypertension, and eats like shit.
The first person is in better shape than the second, than the third, and so on. But how much better are they off in the short term?
Over the course of a year, there isn't likely to be a meaningful difference in mortality for any of the people I mentioned, except maybe the last one (and even then, you'd be surprised how small the one year risk is). Over several years, that risk begins to add up, though.
However, if you extrapolate that over a large population you begin to see benefits from even small shifts in the numbers, and there's nothing about your idea that would be harmful. It's all upside. That's why every clinician always starts with lifestyle modification. An ounce of prevention...
To provide an analogy: a lot of hospitals will always give patients normal saline to rehydrate them--it's cheap, plentiful, and the side effects are pretty low. However, there is a small, but notable risk of acute kidney injury from giving normal saline instead of giving Lactated Ringers. The overall risk to the individual is miniscule, but the population benefits are worth it because treating acute kidney injury is expensive.