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25 April 2020

Metabolic Syndrome

Tag(s): Foreign Affairs, Politics & Economics, Current Affairs
I am indebted to my good friend Chris Woollams[i] for the following information:

“People with ‘Metabolic Syndrome’ have at least three of the following five conditions: high blood pressure, high blood sugar, high triglycerides, low ‘good’ HDL cholesterol and higher abdominal fat and/or obesity. And people with ‘metabolic syndrome’ have a high risk of type-2 diabetes, cardiovascular disease and stroke, Alzheimer’s, kidney disease and non-alcoholic fatty liver disease.

According to the American Heart Association, a staggering 23% of American adults have it and it was a factor common in 99% of deaths from COVID-19. African-Americans, Hispanics and Asians are particularly likely to have it.”[ii]

This extraordinary statistic from a reputable source seems to me to outweigh all the other statistics in which we are drowning. Every day governments around the world attempt to catch up and then get ahead of this dreadful virus. All their thinking must be based on hard scientific evidence as well as good political judgement. But that evidence must be based on hard and accurate and timely data and too much of it isn’t. By the evidence of the American Heart Association it would seem that virtually all deaths from COVID-19 occur in people with not just one underlying health condition but at least three and maybe more.

While I began by quoting statistics for the US we should not be complacent because the British NHS estimates that one in four adults have metabolic syndrome in the UK, i.e. a similar percentage to the US, and this goes up to one in three over the age of 50. With this clear information it should be simple to identify these people through their GPs and prepare an appropriate programme for them involving, quarantine, testing, and priority in vaccines when they are available. Then the rest of us can return to the new normality, still respecting social distancing. The alternative is many more deaths from suicide and neglect of other conditions, and the sheer devastation of the economy for a generation.

The NHS describes the following symptoms of metabolic syndrome:

Metabolic syndrome may be diagnosed if you have three or more of the following symptoms:
  • A waist circumference of 94cm or more in European men , or 90 cm or more in South Asian men
  • A waist circumference of 80cm or more in European and South Asian  women
  • high triglyceride levels (fat in the blood) and low levels of HDL (the “good” cholesterol) in your blood which can lead to atherosclerosis (where arteries become clogged with fatty substances such as cholesterol)
  • high blood pressure that’s consistently 140/90 mmHg or higher
  • an inability to control blood sugar levels (insulin resistance)
  • an increased risk of developing blood clots, such as DVT (deep vein thrombosis)
  • a tendency to develop irritation and swelling of body tissue (inflammation)
It is caused by the Western lifestyle. But as that has gradually spread around the world, it has become a global problem. It is often associated with being overweight or obese, and a lack of physical exercise.   Chris Woollams advises the following ways to prevent or reverse metabolic syndrome:
  1.  Eat better – certain essential changes are simple. Cut out saturated fat foods like red meat, coconut oil and dairy and eat a Rainbow Diet of more vegetables, fruits, nuts, seeds, olive oil, pulses and whole grains. These foods along with good gut bacteria, influence hormones such as Leptin which control metabolic factors.
  2. Eat slower - People who eat their food quickly and rush their meals are at a greater risk of metabolic syndrome.
  3. Fast – Time restricted fasting (where you only eat for eight hours a day, and eat fewer calories during that time) or Intermittent fast (where you eat for five days and fast for two) each reduce blood sugar, blood insulin and cholesterol levels, and reduce weight.
  4. Take exercise – Aerobic exercise is vital to beat metabolic syndrome – do it at least four times a week and, ideally, every day. Exercise should be 45-60 minutes in duration including 20-30 minutes where you are physically out of breath.
  5. Control Stress - Stress Hormones have an over-riding effect on others in your body. Exercise produces endorphins – yoga is the greatest producer per minute. Meditation and prayer produce opioids. Endorphins and opioids work together control stress hormones.
  6. Don’t smoke, cut alcohol – obvious really!
Every Thursday my wife and I join with our neighbours in the 8pm applause for the NHS and the other front line workers in care homes, police forces and all the other emergency workers. I don’t actually clap; instead I bang a gong which I have. It's a Chinese antique so it seems appropriate that I can beat a Chinese object. But are we really praising the NHS? I think we are praising its front line workers but not the NHS as a whole.

I have blogged about the NHS before, usually in the political context of a General Election. It seems to me that we can never have an honest debate about the NHS in the UK as it is like some sacred cow. There are numerous stories in the press on a regular basis of tremendous failures in the NHS, even of wholesale deaths in various hospitals. There are countless cases of cover-ups and of the systematic bad treatment of brave employees who try to blow the whistle. Many of these people have had their lives ruined.

With the current crisis we have a perfect opportunity to examine which health care system is actually the best in coping with the coronavirus and for that matter which has been the worst. Deep Knowledge Ventures was founded in 2014 as a data-driven investment fund focused on the synergetic convergence of Deep Tech, frontier technologies and renowned for the use of sophisticated analytical systems for investment target identification and due-diligence.  The Deep Knowledge Group, which is a consortium of research firms and institutes, in Europe, Asia and North and South America values Knowledge above profit.[iii]

They have set up an initiative to look at more than 70 indicators in 150 countries. Its “Treatment efficiency ranking”, which includes categories such as “Speed and frequency of diagnostic monitoring”, “Level of access to personal medical supplies” and “Size of emergency equipment stockpile” are clearly relevant.

Hardly any of the countries that do well in this analysis have fully nationalised state-run systems. Mixed economy systems, which use a combination of private and public funding score better than monolithic systems like the NHS.

Who comes top? Germany, which appears to be managing the crisis much better than most. Their system is multi-payer with some 100 competing health insurers and many competing hospital groups, predominantly private. Austria and Israel use similar systems and are both in the top 10. So are Japan, South Korea and Taiwan, which have public health insurance systems, rather than state-run health services: the state pays for most health care but procures services from a wide range of competing providers. South Korea and Taiwan are seen as stand-out managers of the coronavirus outbreak, despite their closeness to the source. Japan has the oldest population in the world and is one of the most densely populated countries which increase its risk.

Singapore is another top performer and its system mandates individual medical savings accounts, linked to well-directed government support. It was initially doing well in the crisis but has had a second wave probably due to their large immigrant workforce who don’t benefit from this health system and live in overcrowded conditions. Hong Kong, also in the top 10,  has both a large private system and a public health care system.

The Group’s analysis has been updated to include “Covid-19 safety ranking”. This attempts to assess how fast different healthcare systems can mobilise additional resources, and how efficient they are at testing and diagnosis, etc. Germany, Switzerland and Austria top the European ranking, all of which have systems of multiple health insurers, and competing healthcare providers. The UK is ranked No 30 below Romania and Bulgaria.  There is one ranking where the UK is listed in the top 3: the “Covid-19 risk ranking”.

I would like to think that this terrible crisis would at least have the benefit of forcing the British nation to have an open and honest debate about the best way to organise our health care but don’t  hold your breath.

[i] I have known Chris since Oxford days. After a successful career in advertising he founded the charity CANCERactive. See my blog CANCERactive
Additional source: Britain ranks low in the fight against Covid-19  by Dr Kristian Niemietz Sunday Telegraph 19th April, 2020

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