One year ago

One morning, a little more than a year ago, I remember taking my dogs out to go pee. As I stood by the side of my house, I heard a voice screaming. When I turned my head, I saw my neighbor two houses away angrily chastising me for not wearing a mask outside on my lawn. In her hands were two shopping bags, filled with cereal, ice cream, and Krispy Kreme donuts.

Was she right to be upset? Being a considerable distance from any other human being, I didn’t feel I was putting anyone in danger. Instead, I thought to myself that the real danger was hanging from her two hands.

Of course, even in March 2020, my internal thoughts were not politically correct to voice – certainly not to an angry neighbor. I apologized for making her feel uncomfortable, let my dogs finish their business and went back inside.

Metabolic diseases & COVID-19

After a year of scrambling for solutions, we are finally beginning to appreciate that poor metabolic health is bolstering this pandemic. I am finally seeing titles like, “COVID-19 and metabolic diseases… a renewed focus for research priorities” (Cefalu and Rodgers, 2021) and studies reporting that low HDL and high triglycerides – markers of metabolic syndrome – are important risk factors for severe COVID-19 disease (Masana et al., 2021).

These aren’t minor publications either, but alarming reports published in the world’s top journals, like Cell and Nature. Personally, I couldn’t be more pleased that at least part of the scientific community is willing to call out that metabolic health matters when it comes to saving lives from the COVID-19 pandemic.

What is the toll?

As examples, diabetes and obesity unequivocally increase COVID-19 severity, including a two-fold increase in mortality (Cefalu and Rodgers, 2021). One study noted that, if you’re diabetic, you have a 10% chance of dying within seven days of being hospitalized with COVID-19 (Cariou et al, 2021). Another observed that 31.4% of COVID-19 related deaths occur in people with type 2 diabetes (Barron et al. 2020).

So, how many lives have metabolic diseases contributed to the COVID-19 death toll (of 563,000 lives) this past year? Given that more than one third of Americans have diabetes or pre-diabetes, 42.4% are obese, and 88% have at least one marker of metabolic syndrome (Araujo et al. 2019), the number is not one I’m keen to quantify.

Minority burden

Racial minorities carry a disproportionate burden of metabolic diseases and, consequently, of COVID-19-related deaths. Black Americans have a prevalence of diabetes two-fold that of white Americans, the highest prevalence of obesity among any minority group, and a corresponding 3.5-fold increase in COVID-19-related mortality as compared to non-Hispanic whites.

The racial disparities in COVID-19-related deaths do not appear to be attributable to differences in genetics or immune disposition, or by differences in the prescription of certain medication that interact with SARS-CoV-2 virus (Cefalu and Rodgers, 2021). In other words, it’s not that the virus is racist, but that the systemic biases and inequalities that put racial minorities at greater risk for metabolic diseases also put them at greater risk for being killed by COVID-19.

Therapeutic Carbohydrate Reduction (TCR) as a Solution

There are obviously tremendous gaps, at the population level, among certain racial minorities and white Americans with respect to food availability and affordability. We can and should close the gaps, but this will not happen overnight. Nevertheless, therapeutic carbohydrate reduction (TCR) is a tool we do have at our fingertips to address the epidemic of metabolic diseases, and, thereby, save all Americans from COVID-19.

TCR is effective at reversing obesity, type 2 diabetes, and metabolic syndrome. The Virta health trial found that over two years, individuals who practiced TCR lost 30 pounds and 60% were able to come off of insulin. By contrast, the standard of care control group gained weight and most had to increase their medications. In this study, TCR was shown to be 11 times as effective as standard of care at reversing diabetes, based on markers of glycemic control (Athinarayanan et al. 2019). And, not surprisingly, better glycemic control in diabetes has been associated with lower COVID-19-related mortality.

What’s more, a randomized crossover trial including 16 people with metabolic syndrome showed that, even independent of weight loss, TCR was able to reverse metabolic syndrome in 9 of 16 subjects in just four weeks, as compared to 1 of 16 subjects on an isocaloric lower fat, higher carb diet (Hyde et al. 2019).

It’s intuitively obvious to even a casual thinker that TCR could save lives now, from COVID-19, and also in the future, from other metabolic diseases. When COVID-19 leaves, we will still have an obesity and diabetes problem. It would be nice if we could seize the opportunity to turn this catastrophe into something positive – a catalyst to save future lives from metabolic diseases.

Obstacles in the way

It would be nice to believe that the road from the sorry metabolic state in which we find ourselves, and a future in which where the majority of us are metabolically healthy, was flat and newly paved. Unfortunately, it’s riddled with speed bumps and potholes.

  • Krispy Kreme is incentivizing people to get vaccinated by offering them a free donut every day for the rest of the year after they get their second dose. I hope I don’t need to explain why this makes less than no sense.
  • Saturated fat and LDL are still vilified even though the data are abundantly clear that insulin resistance is the real culprit when it comes to adverse cardiovascular health impacts (Astrup et al. 2020; Dugani et al. 2021).
  • But twice as much of our saturated fat comes from desserts – like those Krispy Kreme donuts – and pizza, than meats and cheese. (USDA, 2020) So that’s confusing!
  • Plus, people are addicted to those sugary Krispy Kreme donuts, biasing the population to point the finger at anything that might prevent them from guiltlessly obtaining their next glycemic high. (Did you know that sugar activates the same brain systems as drugs of abuse, and sugar can cross-sensitize animals to cocaine and amphetamines (Avena et al. 2008)?)
  • Then, we have dieticians telling obese and insulin resistance patients to “eat in moderation” and “eat intuitively.” This sounds like good advice, and I actually agree that it is the ultimately goal. But is it fair to believe that a sugar-addicted person is going to be able to “listen to their body” and “eat intuitively” towards health when their cravings are telling them to grab that free Krispy?
  • Then, those very well-meaning dieticians are being influenced by the processed food industry. In the Dietitian’s Dilemma, an excellent read by registered dietitian Michelle Hurn, she reveals that the Academy of Nutrition and Dietetics is funded by companies like Coca-Cola and Kellogg’s, and that said companies sponsor dietitians’ continuing education credits. The learning objective of one course, sponsored by General Mills, was to teach dieticians and patients about “the role of packaged food in a sustainable diet.”
  • That said, I’ll give the Academy of Nutrition and Dietetics credit for criticizing the USDA Dietary Guidelines for Americans for noting that their review of the literature was incomplete and lacked scientific rigor (Nutrition Coalition, 2020). Then again, what could you expect from a set of guidelines generated by an advisory committee chaired by a religious ideologs and featuring individuals who receive half a million dollars from companies like Nestle (Goodrich 2019)?

Perhaps I’m letting my emotions get the better of me. But when I consider the interlocking, mutually reinforcing set of speed bumps and potholes that are preventing my neighbor from receiving evidence-based advice on how to protect her health from COVID-19, diabetes, obesity, metabolic syndrome, Alzheimer’s disease, and so on, I do get frustrated. That’s not fair to her and it’s harmful to population health.

Imagine if…

Imagine, for a minute, how the world would look now if we all knew that TCR can, in as little as four weeks, reverse metabolic syndrome (Hyde et al. 2019) to save lives.

Imagine if we, as a community, recognized the clear evidence that metabolic health matters for the present moment (Cefalu and Rodgers, 2021; Masana et al., 2021), and for the future health of our country and world.

When COVID-19 shrinks away, obesity and diabetes will still be growing. And free donuts are just making the problem worse.

About Nicholas Norwitz

I completed by DPhil (PhD) at Oxford and will complete my MD at Harvard with the aim of becoming a physician scientist. My career goal is to help change the medical system to a patient-collaborative and metabolic-medicine first system.


  1. Scott Gierhart on April 21, 2021 at 4:29 am

    Great Read! Thank you Nicholas Norwitz

  2. Dalia Zygas on April 21, 2021 at 5:39 am

    Well done! Metabolic disease is a slow, deadly epidemic as well. It is both easy to fix (TCR/ low carb/keto) and truly challenging to address – follow the money!

  3. Matthew on April 21, 2021 at 5:43 am

    Thanks, Nick. We need more physicians like you.

  4. Michelle Owen on April 21, 2021 at 7:23 am

    Brilliant and informative read, thanks

  5. Nancy Vest on April 21, 2021 at 12:42 pm

    I appreciate your ability to tell the truth with compassion.

  6. Katie on April 21, 2021 at 1:01 pm

    Excellent article

  7. Belinda Fettke on April 21, 2021 at 4:31 pm

    A brave and timely opinion piece thank you Nick Norwitz. When COVID-19 shrinks away there is no doubt our obesity and diabetes epidemic will still be growing 🙁

    We need to stop bandaiding sick-care and instead, get to the root cause of the obesity and Type 2 diabetes epidemic. Until then our society will continue to be metabolically vulnerable to a raft of complications.

    Thank you for bringing up the ‘rewards’ of Covid vaccinations… Krispy Kreme is marketing itself brilliantly. And we, as a society, are falling for it 🙁

    We really do need to consider food as medicine and stop industry and religious ideology shaping our low fat, high carb dietary and health guidelines.

    Thank you for broaching this emotive topic and for your heartfelt plea for treating the root cause without industry or ideological bias 🙏

  8. Anne on April 22, 2021 at 12:33 am

    Yep when I hear eat in moderation to those that are sugar and carb addicts I cringe because if you a drug addict or cealic no one tells them to use their drug of choice in moderation or a cealic eat wheat in moderation so why tell a T1D OR T2D eat high carbs moderation of sugar to then take drugs to get their BSL Down make their pancreas to work hard to try and bring their blood sugar spike down whilst still damaging their body. I try my best to eat LC but when you go out to buy lunch or function guess whats on offer.

  9. Patti Berndt on April 23, 2021 at 7:41 am

    Time to expose the influence of Big Food in medicine. Thanks for being a leader in demanding true excellence in medicine/medical research and advocating for a partnership between patients and provider. This is an excellent article.

  10. Dana Eftodie BScN, RN on May 1, 2021 at 2:34 pm

    Excellent, well written! We are truly in the battle of humanity here and right under everyone’s noses– literally too! We need to disseminate well supported information to the masses and keep pressing on! The truth will set us free!

  11. […] research on benefits, see: When COVID-19 Shrinks Away, Our Obesity and Diabetes Epidemic Will Still be Growing (Nicholas Norwitz, Society of Metabolic Health Practitioners, April 20, […]

  12. Molly Rutherford on May 9, 2021 at 5:06 am

    Great article, but I would add that vitamin D deficiency is more likely in people with dark skin, which might provide another explanation for the disparities in outcome. We know that vitamin D is important for proper immune functioning.

  13. James Hall, Family Nurse Practitioner on May 9, 2021 at 5:54 am

    Wonderfully written, thank you for sharing!

  14. Susan Wolver on May 9, 2021 at 2:33 pm

    Bravo Nick.

  15. Kehllee Popovich on May 10, 2021 at 3:30 am

    Sharing widely! Young doctors giving me hope for the future of medicine!

  16. RICHARD C KITCHEN on May 10, 2021 at 5:43 am


  17. Gaja Andzel on May 19, 2021 at 4:04 pm

    well written, so true!

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