In this Q&A session, Glen Finkel and Dr. Westman discuss the risks for COVID-19 in patients with type two diabetes and metabolic-related illnesses and the precautions you should take, as well as Dr. Westman’s opinion on whether or not keto can help fight the Coronavirus.
Glen: How are you treating your patients these days?
Dr. Westman: I’ve been at the Duke clinic since 2006. My life up until the COVID 19 changes happened – I was seeing patients in the clinic pretty much four and a half days a week, hustling from room to room, that sort of thing, and then everything changed. We went to telemedicine and telephone calls and the volume of people wanting to stay in the program went down, although people do still want to be in the program.
Now we’re a couple of months into the change and we’re just starting to open up one of the clinics, but most of my work now is by phone or by video or video teleconference within the protected university software program that we have.
When I go to our clinic building, you get checked for a fever at the entrance. If your temperature is high, you get funneled in a certain way, separate from other people just in case you have Coronavirus, so we’re creating that safe environment for people, most of my patients are not ill, meaning they don’t feel sick so they don’t want to be in a clinic where there are really sick people.
But what I’ve learned and heard from many of my patients is that they can measure things at home, like their weight and oftentimes even the blood pressure and blood sugar. I don’t really need them to come back to the clinic every time. So we’re actually going to be changing what we do to match the individual needs. And I think a lot of my work going forward will be incorporating video, telemedicine, and the telephone so that it saves people time from coming back.
If they’re doing well. They don’t have to come back and tell me that they’re doing well. We can do that remotely. But trouble comes in when I’m dealing with people who are medically sick, people who have diabetes and high blood pressure, and heart failure – the complicated medical folks, I still need to have them come in to measure the physical exam and look for fluid. It kind of depends on the severity of the medical problems. I’ve become much more comfortable just helping people change their food.
If they have no medical problems, I’m not introducing a pill or a product or doing anything that’s unsafe. We’re just changing food. It’s changed my clinical practice in a big way, and I hope to learn from it.
Glen: For people that possibly want to make appointments with you, do you take out of state patients via telemedicine right now?
Dr. Westman: Currently the rules are kind of paused, but the rules are that since I’m licensed in North Carolina, I can really only do a doctor/patient relationship kind of consult in North Carolina. I know there are a lot of doctors who push the limits on that, but those are the rules currently. Occasionally I’ll do a consult one time for someone at a distance, but they have to go through the Duke system, so Duke will endorse my treatment like that as long as it’s not everything I do.
Glen: We’ve heard that with COVID-19, people with type two diabetes or metabolic-related illnesses are at greater risk when they’ve contracted the Coronavirus. What are your thoughts on this?
Dr. Westman: The data that comes out is kind of like early results in an election. You don’t really know everything until time passes and you do more research. But it does look like the other underlying comorbidities that we’ve been treating for years with a keto diet are increasing the susceptibility to getting the virus and then also to having bad outcomes once you do get it.
Metabolic health is important for immunity to not get a virus or any kind of sickness and we’ve heard that a lot. I’ve done keto for X number of years, and gosh, I’ve never gotten a cold. It’s one of those things that hasn’t been well studied, but we think it has to do with better immunity and nutrition. And then the idea that if you’re in better health, you’re going to be able to withstand the tough physical battle when you’re in an ICU. Once you get sick, and the disease gets worse, I think a lot of the mortality has to do with your general physical condition, such as a predisposition to the clotting.
Everyone wants to blend what they know to try to help out and I’ve been thinking that my input on how keto could help COVID 19 is not welcome at the moment. It’s kind of like trying to use it for the wrong reason – to get in on the big popularity. But if I had a patient who got it and was fixed by doing a keto diet, I would certainly think that’s valuable information. These are hard studies to do, especially when it’s uncontrolled. Somehow this week, they got tens of thousands of people in a clinical study with the drug hydroxychloroquine to see if it helps and it didn’t help.
It seems to me that this was more infectious than people thought. It was affecting healthcare workers. In my lifetime, there’s been no risk really for a healthcare worker to die from taking care of someone, most hospital employees are not ever at risk. COVID 19 started infecting and killing healthcare workers so this is a different beast than influenza.
Even if you say the numbers are no different, the penetration into healthcare workers getting sick and dying is brand new. These were things that made me realize that this is something different and new. My response is to take extra precautions and not to be cavalier.
Glen: There are so many different articles that we read and a lot of misinformation. It’s no wonder that the public is completely confused. I’ve got maybe three or four questions that can help some other people. One of them is – “I’m 65 years old and worried that my state’s lifting restrictions. Do you think that I should continue to isolate?”
Dr. Westman: The decision is a personal one. I’m 60, so I’m about that age and I go out every now and then, and I can stay at home for work. But now I’m going back to work and a lot of people have done that.
I protect myself as best I can, washing hands frequently, but I’ve been trained, I’ve seen that in medical training when I was a medical student or resident I washed my hands. You do it very carefully, you scrub it with a brush and then you put it under the water so that the water drips down and then you put on surgical gloves and you go into an operating room with a mask around your face.
You can open up someone’s body and not bring infection into it. This is done every day in the operating room, so I know that being very careful about what I do can help. Now, do you have to go to that extreme, to wear gloves and all that? No, I don’t think so. Whenever I go out, I’ll come back and I’ll wash my hands and I get back into my house. I’ll put up my mask and let it hang on the hook, and I don’t wash it all the time.
The mask is to protect other people from you if you’re asymptomatic and you don’t know. About 40% of people will spread the Coronavirus without even knowing they’re sick. That’s the latest statistic. If someone’s out there recklessly not wearing a mask, I’m protecting myself from them if they’re sick.
So with my patients, as we were discussing, because diabetes, obesity, other metabolic problems make you a higher risk for getting the virus and for having worse outcomes, I’ve been pretty conservative or pretty strict about staying at home as best you can, and when you do go out, cover your face. A lot of my patients locally can get groceries delivered to them and they’re still staying home. I think that’s probably the best.
I’m kind of shocked that people are congregating together without any regard. We’ve already seen some churches or parties or weddings where people don’t just get sick, they die. There are some stories now coming out, so it’s kind of like a six week lag time. Six weeks from now, we’re going to see what the effects of opening now are.
Given your situation, how are you handling it Glen?
Glen: We live in South Africa and we’ve got one of the toughest lockdowns in the world. There does seem to be such conflicting reports and we’re not qualified to understand what is right and what is wrong with these conflicting reports in terms of – does lockdown help or does it not help? Is it just delaying the inevitable?
I don’t think we’re going to have all the answers now. I think that we’re going to have a lot more answers in the next six months possibly to a year. You read these articles where the CDC is changing their recommendations on lockdowns and they’re changing their recommendations on whether the virus is able to easily spread on surfaces.
As a person that’s sitting back and just watching what’s going on, we can’t make a living, we’re locked down, we can’t get herd immunity. Do we even know what herd immunity is? I think that when somebody has lost their ability to make a living, it’s very tough to say to that person who can’t feed their family that you have to stay locked down. I wouldn’t like to be the person that’s making these decisions.
Dr. Westman: When you get to a certain level in politics or any position, you can’t win, you can’t please everybody. How are you handling it? Certainly, your kids probably go out running? Or are you jogging? Are you not able to do that?
Glen: We’ve got a window. Some of the rules for us are so bizarre, for example, an exercise rule. We have five different stages, five being the worst where we’re in complete lockdown. Then it goes from four to three to two to one, and we now are currently in level four, which means that we can exercise between the hours of six and nine in the morning, so it’s a three-hour window.
All the areas where people want to exercise are completely filled with people so it just makes absolutely no sense. They’ve closed all the recreational parks and mountain trails, they’ve closed everything and you can’t even go and run on the grass next to the sidewalk. In Cape Town, for example, where I live, the sun only comes up at about eight o’clock and you’ve only got an hour between eight and nine. Now you’ve got everyone that wants to exercise, all exercising at the same time.
Dr. Westman: That happens here where you open a beach and then people come out and don’t practice social distancing, so some states have had to close the beaches because when you open them, people don’t abide by the rules.
I think that’s going to be natural. I guess I would err on the side of trusting the doctors, infectious disease people, public health people, and those who went through Ebola, and the SARS epidemic before.
The problem with our current CDC centers for disease control is that it’s being muzzled or what they’re trying to get out is being changed by our current federal government. That’s being done in plain sight. What’s fascinating about our current federal government is they just do things out in the open.
The guidance from CDC was actually really strict and now it’s all watered down so I don’t know that they’re the best source to follow. I’ve been following a lot of the public health reports and I’m looking at the California model as being the one that’s most influenced by public health people.
I’m still pretty conservative and sort of strict in recommending people not to go out. Although I have seen that go to the other extreme of someone being really paranoid, and the idea of taking your groceries and putting them in timeout for two days so any virus on it dies. To me, that’s a little too extreme.