Posted 19 May 2020
I have a phrase I use (perhaps a little too often) to explain how genes and lifestyle interact to determine your metabolic health:
“Genes load the gun; your lifestyle choices decide if the gun is fired”.
For example, you may have a genetic make-up that increases your chances of developing type 2 diabetes. Whether you actually become diabetic then depends on the choices you make regarding diet, exercise, sleep and so on.
As with all analogies there can be over-simplification. Some lifestyle ‘choices’ may not be up to the individual: External stressors can have a big effect on health outcomes (as lockdown is going to show in coming months and years) and some lifestyle options will be subject to constraints that may make them unachievable for the individual.
But another impediment to making the ‘right’ choices is all too often not knowing what are indeed the right choices. What should you eat? How many hours of sleep should I have? What is the best form of exercise of me? The answers are all too often confused. And maybe that confusion has contributed to our current problems.
Because of that, my analogy needs an update:
“Genes load the gun; your lifestyle choices decide if the gun is fired; coronavirus decides where the gun is pointing”.
And yet we all seem to be off-guard looking in every direction other than where the gun is pointing.
We agonise over whether to send children back to school when the infection fatality rate of children (indeed for all under 60) is less than seasonal flu. We criticise whether lockdown was too late yet countries that did not lockdown at all have fared better. We worry about coming out of lockdown whilst those countries that are venturing out are not (yet) falling into the abyss. We worry about people dying of COVID19 whereas now half of all cancer patients are not receiving scheduled treatments, most of the suspected new cancer cases are not entering the health care system, 85% of organ transplants are not taking place, 40% of stroke evaluations are down and routine vaccinations to children are down by one half (these are US data).
Despite study after study showing how strongly co-mordibidties are correlated to COVID19 outcome, we have no more than the occasional platitude that we will deal with ‘it’ later. Yet the more co-morbidities you have (hypertension, excess body fat, type 2 diabetes, heart disease etc) the more compounded your risk. In fact, data increasingly point to only around one per cent of all COVID deaths being in patients with none of the co-morbidities. Having type 2 diabetes alone could increase your risk by more than ten fold.
Whilst your genes may well have loaded the gun and the virus decided where it is pointed, most of our lifestyles choices are still in our control to stop it being fired. If we had the clear tools and knowledge to reduce our own co-morbidites, the risk of coronavirus would be greatly reduced (the ‘terrain’ would be less fertile for the virus) and our healthcare system would then be able to get on with ‘business as usual’ and save lives. Looking the other way does not help.
And no matter how close the finger is to pulling the trigger, making changes right now can make all the difference. Metabolic illness is reversible.
Whilst it may be the case that the lack of clear messages on what constitutes good lifestyles choices is partly to blame, some things should be quite obvious. It is deeply saddening to see data that sales of junk food are rising in lockdown and also hear reports that the police had to turn drivers away from queues at a recently reopened Burger King. What chance does our metabolic health have under those circumstances?
Maybe we should be harsh: In the time of coronavirus “fast food costs lives”.
Of course much of it is money driven. Krispy Kreme’s ‘Doughforce project’ is delivering doughnuts to hospitals I concur with the Dieticians Association in calling this apparent altruism nothing more than “a thinly veiled attempt to build brand awareness and increase sales”. Product placement is nothing new, after all, and where better than a hospital to place your product at a time when we are all looking in that direction.
What hope have we got?