So far, COVID-19 doesn’t like to play fair. It seems to have a gender bias.
While the majority of people who’ve been infected are either asymptomatic or have minor non-life threatening symptoms, there are others who have suffered significantly and too many who’ve succumbed to the virus. As more data is gathered providing a better understanding of its methodology, one thing in particular glaringly stands out — COVID-19 strikes men harder than women.
How Men Compare to Women
When reading about gender differences and COVID-19, the virus almost seems to seek out and target those of the male gender. For instance, a study in April published in JAMA found that out of 5,700 patients hospitalized for COVID-19 in the New York City area, 60% were men.
Another paper (unpublished) from the medical research site MedRxiv, found that out of 14,000 patients infected from multiple countries, it was men, especially 50 and older, who had the greatest risk for hospitalization, mechanical ventilation, and death, even after adjusting for common risk factors like underlying health conditions. This same study found that even though it was an approximate equal number of men and women who contracted the virus, the men were likely to develop more severe symptoms and die from it.
And then there’s a large study from the Intensive Care National Audit and Research Center (ICNARC) from countries such as England, Wales, and Northern Ireland which also backs up these findings: around 70% of critically ill patients admitted to intensive care have been men and again, the men are dying at higher rates than women.
Why are men despairingly more vulnerable to this insidious viral infection?
As a urologist and strong advocate of men and their health, I have a couple of theories as to why men have a higher risk with more severe cases: Abdominal obesity and low Vitamin D levels.
Regarding Men With Abdominal Obesity
Obesity in the United States has steadily risen since the late 1980’s. In 1990, obese adults made up less than 15% of the population in most U.S. states. By 2010, 36 states had obesity rates of 25% or higher. Today, the most recent statistics place the obesity epidemic at a staggering 42.4% among adults.
By 2016, 75% of all U.S. men were either overweight or obese
Men who gain excess weight will invariably store those extra pounds predominately in their central abdominal region known as visceral fat or simply as belly fat.
Having a pot belly may seem relatively harmless but don’t let looks deceive you. A large waist girth (for men, 40 inches or greater) can be downright dangerous and is strongly associated with an increased risk of coronary artery disease, type 2 diabetes, elevated triglycerides, hypertension, cancer, and general overall mortality.
Visceral fat can also increase risk of lung problems — one of the prime organs attacked by COVID-19 — due to having less room in the chest reducing lung function.
Women also can carry excess weight in their belly; however, women have more of a tendency to distribute their weight in their hips, thighs, and buttocks, in the form of a relatively harmless fat called subcutaneous fat
Visceral fat is different from the subcutaneous fat stored on a person’s thighs. Subcutaneous fat is located under the skin and accounts for 90% of body fat. Visceral fat, also known as intra-abdominal fat, makes up the remaining 10% and is stored deep within the abdominal cavity amongst other organs.
This fat stored in a man’s midsection is "biologically active," almost like an additional organ secreting hormones such as adiponectin and leptin which are related to appetite and metabolism. This activity of visceral fat results in an inflammatory state strongly linked to metabolic syndrome.
When looking at why obese men are at a greater risk for severe COVID-19, one explanation is that the virus has an affinity for human angiotensin converting enzyme 2 (ACE2), which has been shown to be the presumed receptor for the entry of COVID-19 into host cells. Obesity means a person has more adipose tissue and adipose tissue has an increased number of ACE2-expressing cells and a larger amount of ACE2.
We know from other respiratory infections, obesity increases vulnerability by possibly increasing the duration of virus shedding.
Past studies have found that obese patients with influenza A shed virus 42 percent longer than adults who are not obese.
Then there is the fact that compared to patients with a healthy body weight, COVID-19 patients with a body mass index (BMI) or 30 or greater, tended to have a more severe form of the infection.
Men With Low Vitamin D Levels
If men intend to successfully fight battles with infectious diseases, they’ll need to maintain adequate Vitamin D levels. That’s because many may not realize, but Vitamin D is actually a hormone with a wide range of functions in the body including supporting improved resistance to colds and flu.
It’s been shown from past studies that deficiencies of Vitamin D increases susceptibility to infections which would include COVID-19.
However, past studies have also shown that men are more likely to be deficient in Vitamin D than women. A 2018 study found that men had a higher prevalence of Vitamin D deficiency when compared to women. Factors for this included a low consumption of milk, abdominal fat, and lack of taking a Vitamin D supplement. Another study found that when compared to women, blood levels of Vitamin D were consistently lower in men.
It’s also known that obesity is associated with Vitamin D deficiency as shown by a 2012 cross sectional study. Men who were morbidly obese had significantly higher chances of a Vitamin D deficiency than women.
What’s the link then between Vitamin D deficiency and COVID-19? A recent editorial published in the journal Alimentary Pharmacology and Therapeutics, is showing a link between Vitamin D playing a role in suppressing the severe inflammatory cytokine response seen in critically ill COVID-19 patients and COVID-19 deaths.
This study focused on where men lived showing that living above the 35th degree latitude North, such as New York, received insufficient sunlight necessary to make Vitamin D from late fall through early spring. However, Nordic countries like Iceland, where Vitamin D supplementation is widespread resulting in lower deficiencies among their citizens, also had lower mortality rates of COVID-19.
Another study reviewed evidence supporting Vitamin D’s role in reducing the risk of infection and death from COVID-19. It stated the goal would be to raise 25(OH)D concentrations by taking therapeutic doses prescribed by a doctor for anyone deficient in Vitamin D to prevent infection of the virus and encouraged more randomized controlled trials and large population studies to evaluate recommendations.
A response in the BMJ argued for more research on Vitamin D deficiency related to the infection, progression, severity, and mortality in COVID-19 patients. It was also noted in this same paper that a 2008 review stated that 84 percent of African American men and women over the age of 65, were Vitamin D deficient. African American men have been especially hammered by COVID-19.
Advice for men
Clearly, numerous studies are associating that men who are both obese and Vitamin D deficient, are at an increased risk for severe complications and death from COVID-19.
So, what’s my best advice for men?
First I want men of all ages to continue practicimg social distancing, frequent hand washing, and wearing a face mask reducing their risk of contracting COVID-19.
For men age 65 and older or of any age with co-morbidities such as diabetes, heart disease, or lung disease, they should continue to stay home.
Now, the good news is obesity and Vitamin D deficiencies are both manageable and can be reversed.
Let’s take obesity. Begin with your diet.
The biggest driver of weight loss begins by cutting out unhealthy foods providing excess calories typically coming from sugary beverages, fried foods, alcohol, and large portion sizes. Replace with more fruit, vegetables, whole grains, nuts, beans, fatty fish, lean meat, and non-calorie beverages particularly water.
While making smart food choices starts the engine for losing weight, consistent exercise is what will maintain and keep weight off long term. With your doctor’s approval, strive to get in at least 30 to 60 minutes most days of the week of some form of exercise you enjoy.
Walking, jogging, swimming, bicycling, any activity elevating your heart rate for a certain length of time is good.
As far as raising Vitamin D, ask your doctor to take a simple blood test measuring your level. If you are deficient and depending on how low, your healthcare provider likely will recommend a daily supplementation of 1,000 to 2,000 IU of Vitamin D3 as a good start but they may prescribe a higher dose initially.
Besides supplementation, Vitamin D is made in the body by direct skin exposure to UV rays from sunlight. The darker your skin, the longer you need to be outdoors (up to at least 30 minutes) to activate this production. Natural food sources are not plentiful but do include fatty fish such as salmon, albacore tuna or sardines, egg yolks, or Vitamin D enriched milk. Here’s a fun fact: mushrooms are the only source of Vitamin D in the produce aisle.
Men, make this your time to take care of yourself.
Dr. David Samadi is Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He is a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City. He is regarded as one of the leading prostate surgeons in the U.S., trained in oncology, open, laparoscopic, and robotic surgery. He has vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Read Dr. David Samadi’s Reports – More Here.