Falling Down
On
New evidence indicates that the body can sense gravity, and by manipulating the sensors we can trick our metabolism into losing fat while retaining muscle. The modern diet makes this mechanism less effective, and Covid lockdowns have made matters even worse; but there are nutritional work-arounds which enhance fat loss and protect our joints at the same time.
The Covid lock-downs have been ruinously expensive. They have hit the world economy hard, shrinking it by roughly 6%, killing jobs and plunging many into poverty (1). They have led to increased suicides, marital breakdowns, spousal and child and drug abuse, and have probably caused more deaths than covid itself (2-4). And they have not been particularly effective in containing Covid (5).
We can now see that the real Covidiots are the politicians who, despite the early semi-controlled Diamond Princess and Gangelt data sets which showed that Covid was not a serious public health issue (6-8), used it as an excuse to reduce our freedoms and increase theirs. But it is the long-term effects of lockdown that will be the most expensive, and the most destructive.
A third of the global population aged ≥15 years is already insufficiently physical active. This contributes to approximately 3.2 million deaths every year by increasing obesity, diabetes, cardiovascular diseases, osteoporosis, cancer, cognitive decline (9, 10) and early death (11).
Americans already spend 7.7 hours a day seated (12). When lockdown forces folk to shelter and work at home, sitting down goes up to 11.7 hours a day (13, 14).
This has made an already astonishingly fat nation, fatter. About half the population have gained weight, by an average of 29 lbs (14). It’s a similar story in other countries which have gone the lockdown route (145-23).
This is doing enormous damage to our health prospects, damage which will continue long after the current crop of political covidiots have been thrown out of office and onto the ash heap of history. But you don’t have to be a victim. You can take control over your own life – and you can start by standing up, and walking.
Walking from the couch to the fridge doesn’t count. Sorry. To protect your health, stand up every hour or so and climb a couple of flights of stairs, or do 10 minutes of stretches, or both (24).
Muscular exertion activates the muscle enzyme lipoprotein lipase (LPL), which helps to keep your blood lipids under control. It also activates the energy switch AMP-kinase, of which more later. Aim for a minimum 25-30 minutes / day of moderate physical activity (25).
Switch to a low-cal anti-inflammatory diet if you can. Next, add gravity. Not Gravity, the tedious Bullock / Cluney vehicle – you’re trying to cut down on couch time, remember? I mean gravity, the kind you can feel.
Consider sense and sensibility. Mystics and Janeites claim that we have as many as 53 senses (26). Neuroscientists claim a more conservative 9, which starts with the basic 5 and adds thermoception, nocioception, proprioception and equilibrioception. Very recently, a tenth sense has been added to the list; the sense of weight, or gravity. And it may be the key to losing those lockdown love handles.
When lab rats or mice are weighted down with lead pellets they lose substantial amounts of weight (27, 28). This is almost exclusively adipose tissue. Unlike dieting, there is little if any loss of muscle mass (27-29), making lead an ideal weight loss strategy for the lazy. The Gothenburg researchers who did this work postulated a body weight regulating mechanism which worked in parallel with the leptin system, and called it ‘the gravitostat’.
They reproduced the experiment in a clinical trial, which generated the same result (30). Their paper concludes, ‘Increased weight loading reduces body weight and fat mass in obese subjects in a similar way as previously shown in obese rodents. These findings demonstrate that there is a loading-dependent homeostatic regulation of body weight, the gravitostat, also in humans.’
I must add that an Oregon team which actually shot a colony of rats into space decided that the gravitostat didn’t exist, and suggested that weight loss in the Swedish mice was due to injury and/or stress (31). The Oregonians were seemingly unaware of the Swedes’ successful clinical trial (30) and the science is not yet settled; but at the time of writing I think the Gothenberg group (and another at Columbia U) outweighs them (32, 33).
The concept of a gravitostat raises some interesting questions. If the gravitostat actually exists, in which tissue or tissues is it located? What does it consist of? How does it work? Can it be manipulated by a molecule that you could, perhaps, put in a pill?
If I were to design a gravitostat I would place it in or around the knee joints because the higher in the body you locate such a sensor, the less able it is to respond to total body weight. When your legs are not in use (ie when you sit down) it would be disabled. This is one reason why sitting makes you fat – and is so bad for your health (34-36).
There is some experimental evidence for a leg or knee-based gravitostat.
Previous work with mice in low-gravity models showed that de-loading the hind limbs leads to loss of muscle (37) and bone (38), while increased loading has the reverse effects (38). These effects are mediated by the mechano-transducer cartilage protein Piezo1 (39), making Piezo1 a plausible weight sensor in the still theoretical gravitostat; and an exercise sensor also (40-42).
Piezo1 has a broader role.
In bone Piezo1 senses load and torque, and is involved in bone maintenance and growth in response to exercise (43). In the arteries it senses shear and stretch, and is a sensor in the homeostatic regulation of blood flow whenever requirements change (44). It guides the growth of tissues from embryogenesis onwards (45), and basically allows higher life forms to respond to the constantly changing physical demands of living in the material world (46).
If Piezo1 is a sensor, what is/are the effectors? The sestrins are prime candidates, as they are stress-responsive and activate AMP-kinase (47), which preferentially burns adipose tissue while conserving lean muscle mass (48). However, the sestrins are autocoids, and act very locally unless there is a general up-regulation of sestrins in multiple muscle groups.
Standing and walking about under normal (Earth) gravity is probably enough to achieve this. Upping the G-force by wearing 20 kg of lead weights on your back should activate even more AMP-K, increase your BMR and lose body fat – which is what the Swedes demonstrated. For evolutionary reasons, increased loading would be expected to burn fat rather than the muscle needed to carry the increased weight, so the idea seems plausible.
There are additional reasons to put on a full metal jacket. Unloading the hind limbs (ie sitting too much) damages the metabolism and the miocrobiome (49). Due probably to the reduction of stresses in the extra-cellular matrix, it also degrades the machinery of apoptosis (50) in ways which slow wound healing and increase the risk of clinical cancer (51).
These mechanisms are relevant to astronauts and to couch potatoes too (ie 52) who are, in physiological and metabolic terms, sub-orbital astronauts. And all of them would be switched off by amping up the G’s, and loading up with lead. But why is the gravitostat not triggered by ‘normal’ weight gain, I hear you ask?
I believe the gravitostat evolved to respond to relatively acute changes in loading such as the sudden and repetitive 4-fold increased loading of the knee which occurs when running (53, 54). Excess weight is heavily penalized in the wild because it makes you more likely to transition from predator to prey and disappear from the gene pool; and I can say, from personal experience, that running makes you lose weight fast.
The gravitostat fails in the modern world because we are excessively sedentary, and it is not designed to respond to gradual increases in weight which take place over months and years. It adjusts, in the same way as baroreceptors do to the slow development of essential hypertension – which you will acquire, along with adiposity, if you eat the modern, ultra-processed diet. And as adiposity degrades cartilage in weight-bearing joints (55), it may degrade the gravitostat too.
Now we come to a crunch. Can the gravitostat be triggered by nutritional components? The answer is, probably yes.
The polyphenol resveratrol protects against the damaging effects of de-loading by acting as an exercise mimetic (56); and does so by activating AMP-K directly (57). Other nutrients which do the same thing include the polyphenol quercetin (57), the sapogenin dammaranes (58), and the omega 3 fatty acid EPA (59).
Dietary intakes of all these protective compounds declined dramatically after the nutrition transition (60), and have fallen further as a result of lockdown. Many people have switched to comfort (aka junk) foods, which are depleted in polyphenols, saponins and EPA.
The ultra-processed diet is also deficient in prebiotic fiber, leading directly to dysbiosis; and all of these nutritional gaps interact with the enforced sedentarism to damage the gravitostat (61) and weight-bearing joints in general (61). They also make people fatter, sicker and more vulnerable to Covid (ie 62, 63).
Politicians are not scientists, and in my experience they rarely think of second order effects other than those which benefit them personally. Politically motivated lockdown is probably the most egregious error in public health of all time (64). It has made the general population more likely to die of Covid (64-68) and more vulnerable to future pandemics, which will come.
In the next post. Why the spectrum disorders are increasing, how to protect your unborn baby’s brain, and why I am such a rude and objectionable person.
References
- Global Economic Effects of Covid-19. Congressional Research Service, Feb 2021. https://fas.org/sgp/crs/row/R46270.pdf
- https://www.therecoveryvillage.com/drug-addiction/news/covid-19-substance-use-map/
- https://www.governor.ny.gov/news/following-spike-domestic-violence-during-covid-19-pandemic-secretary-governor-melissa-derosa
- https://www.internationalaffairs.org.au/australianoutlook/lockdowns-could-kill-more-people-than-covid-19/
- Chin V, Ioannidis JPA, Cripps S. Effects of non-pharmaceutical interventions on COVID-19: a Tale of Three Models. medRxiv doi: https://doi.org/10.1101/2020.07.22.20160341
- https://www.land.nrw/sites/default/files/asset/document/zwischenergebnis_covid19_case_study_gangelt_0.pdf
- Prof. Hendrik Streeck, Gangelt data. https://youtu.be/vrL9QKGQrWk
- https://www.medrxiv.org/content/10.1101/2020.03.05.20031773v2.full.pdf
- World Health Organization, 2020. Physical inactivity: a global public health problem: https://www.who.int/dietphysicalactivity/factsheet_inactivity/en/
- Patterson R, McNamara E, Tainio M, de Sá TH, Smith AD, Sharp SJ, Edwards P, Woodcock J, Brage S, Wijndaele K. Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol. 2018 Sep; 33(9):811-829.
- Katzmarzyk PT, Powell KE, Jakicic JM, Troiano RP, Piercy K, Tennant B, 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE. Sedentary Behavior and Health: Update from the 2018 Physical Activity Guidelines Advisory Committee. Med Sci Sports Exerc. 2019 Jun; 51(6):1227-1241.
- Tigbe W, Granat M, Sattar N, Lean MEJ. Time spent in sedentary posture is associated with waist circumference and cardiovascular risk. Int J Obes 41, 689–696 (2017).
- https://www.prnewswire.com/news-releases/survey-reveals-increased-time-sitting-at-home-during-the-pandemic-has-been-a-pain-in-the-butt–literally-301161729.html#:~:text=The%20%22State%20of%20Sitting%20at,to%20their%20days%20in%202020.
- Dunton, G.F., Do, B. & Wang, S.D. Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S. BMC Public Health 20, 1351 (2020).
- https://www.apa.org/news/press/releases/stress/2021/one-year-pandemic-stress
- Jia P, Zhang L, Yu W, Yu B, Liu M, Zhang D, Yang S. Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS). Int J Obes 45, 695–699 (2021).
- Kim E.S, Kwon Y, Choe YH, Kim Mj. COVID-19-related school closing aggravate obesity and glucose intolerance in pediatric patients with obesity. Sci Rep 11, 5494
- Dragun R, Veček NN, Marendić M, Pribisalić A, Đivić G, Cena H, Polašek O, Kolčić I. Have Lifestyle Habits and Psychological Well-Being Changed among Adolescents and Medical Students Due to COVID-19 Lockdown in Croatia? Nutrients. 2020 Dec 30;13(1):97.
- Ruissen MM, Regeer H, Landstra CP, Schroijen M, Jazet I, Nijhoff MF, Pijl H, Ballieux BEPB, Dekkers O, Huisman SD, de Koning EJP. Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic. BMJ Open Diabetes Res Care. 2021 Jan;9(1):e002035.
- Rodríguez-Larrad A, Mañas A, Labayen I, González-Gross M, Espin A, Aznar S, Serrano-Sánchez JA, Vera-Garcia FJ, González-Lamuño D, Ara I, Carrasco-Páez L, Castro-Piñero J, Gómez-Cabrera MC, Márquez S, Tur JA, Gusi N, Benito PJ, Moliner-Urdiales D, Ruiz JR, Ortega FB, Jiménez-Pavón D, Casajús JA, Irazusta J. Impact of COVID-19 Confinement on Physical Activity and Sedentary Behaviour in Spanish University Students: Role of Gender. Int J Environ Res Public Health. 2021 Jan 6;18(2):369.
- Alonso-Martínez AM, Ramírez-Vélez R, García-Alonso Y, Izquierdo M, García-Hermoso A. Physical Activity, Sedentary Behavior, Sleep and Self-Regulation in Spanish Preschoolers during the COVID-19 Lockdown. Int J Environ Res Public Health. 2021 Jan 15;18(2):693.
- Pérez-Rodrigo C, Gianzo Citores M, Hervás Bárbara G, Ruiz-Litago F, Casis Sáenz L, Arija V, López-Sobaler AM, Martínez de Victoria E, Ortega RM, Partearroyo T, Quiles-Izquierdo J, Ribas-Barba L, Rodríguez-Martín A, Salvador Castell G, Tur JA, Varela-Moreiras G, Serra-Majem L, Aranceta-Bartrina J. Patterns of Change in Dietary Habits and Physical Activity during Lockdown in Spain Due to the COVID-19 Pandemic. Nutrients. 2021 Jan 21;13(2):300.
- Zhou J, Xie X, Guo B, Pei R, Pei X, Yang S, Jia P. Impact of COVID-19 Lockdown on Physical Activity Among the Chinese Youths: The COVID-19 Impact on Lifestyle Change Survey (COINLICS). Front Public Health. 2021 Feb 4;9:592795.
- Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw JE, Zimmet PZ, Owen N. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care. 2008 Apr; 31(4):661-6.
- Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks. Korean J Fam Med. 2020 Nov;41(6):365-373.
- https://www.macrobioticsinternational.com/site/assets/files/1069/macint_53_senses.pdf
- Jansson JO, Palsdottir V, Hägg DA, Schéle E, Dickson SL, Anesten F, Bake T, Montelius M, Bellman J, Johansson ME, Cone RD, Drucker DJ, Wu J, Aleksic B, Törnqvist AE, Sjögren K, Gustafsson JÅ, Windahl SH, Ohlsson C. Body weight homeostat that regulates fat mass independently of leptin in rats and mice. Proc Natl Acad Sci U S A. 2018 Jan 9;115(2):427-432.
- Ohlsson C, Hägg DA, Hammarhjelm F, Dalmau Gasull A, Bellman J, Windahl SH, Palsdottir V, Jansson JO. The Gravitostat Regulates Fat Mass in Obese Male Mice While Leptin Regulates Fat Mass in Lean Male Mice. Endocrinology. 2018 Jul 1;159(7):2676-2682.
- Bake T, Peris-Sampedro F, Wáczek Z, et al. The gravitostat exerts larger metabolic effects in diet-induced obese (DIO) rats than in lean rats. (unpublished).
- Ohlsson C, Gidestrand E, Bellman J, Larsson C, Palsdottir V, Hägg D, Jansson PA, Jansson JO. Increased weight loading reduces body weight and body fat in obese subjects – A proof of concept randomized clinical trial. EClinical Medicine. 2020 Apr 30;22:100338.
- Turner RT, Branscum AJ, Wong CP, Iwaniec UT, Morey-Holton E. Studies in microgravity, simulated microgravity and gravity do not support a gravitostat. J Endocrinol. 2020 Dec;247(3):273-282.
- Palsdottir V, Windahl SH, Hagg DA, Keantar H, Bellman J, Buchanan A. Interactions between the gravitostat and the fibroblast growth factor system for the regulation of body weight. Endocrinology. 2019;160(5):1057–1064.
- Ravussin Y, Edwin E, Gallop M, Xu L, Bartolomé A, Kraakman MJ, LeDuc CA, Ferrante AW Jr. Evidence for a Non-leptin System that Defends against Weight Gain in Overfeeding. Cell Metab. 2018 Aug 7;28(2):289-299.e5.
- Duvivier BMFM, Bolijn JE, Koster A, Schalkwijk CG, Savelberg HHCM, Schaper NC. Reducing sitting time versus adding exercise: differential effects on biomarkers of endothelial dysfunction and metabolic risk. Sci Rep. 2018 Jun 5;8(1):8657.
- Duvivier BM, Schaper NC, Hesselink MK, van Kan L, Stienen N, Winkens B, Koster A, Savelberg HH. Breaking sitting with light activities vs structured exercise: a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes. Diabetologia. 2017 Mar;60(3):490-498.
- Seyam M, Kashoo F, Alqahtani M, Alzhrani M, Aldhafiri F, Ahmad M. Effect of Walking on Sand with Dietary Intervention in OverweightType 2 Diabetes Mellitus Patients: A Randomized Controlled Trial. Healthcare (Basel). 2020 Sep 29;8(4):370.
- Cadena SM, Zhang Y, Fang J, Brachat S, Kuss P, Giorgetti E, Stodieck LS, Kneissel M, Glass DJ. Skeletal muscle in MuRF1 null mice is not spared in low-gravity conditions, indicating atrophy proceeds by unique mechanisms in space. Sci Rep. 2019 Jun 28;9(1):9397.
- Tominari T, Ichimaru R, Taniguchi K, Yumoto A, Shirakawa M, Matsumoto C, Watanabe K, Hirata M, Itoh Y, Shiba D, Miyaura C, Inada M. Hypergravity and microgravity exhibited reversal effects on the bone and muscle mass in mice. Sci Rep. 2019 Apr 29;9(1):6614.
- Sun W, Chi S, Li Y, Ling S, Tan Y, Xu Y, Jiang F, Li J, Liu C, Zhong G, Cao D, Jin X, Zhao D, Gao X, Liu Z, Xiao B, Li Y. The mechanosensitive Piezo1 channel is required for bone formation. Elife. 2019 Jul 10;8:e47454.
- Beech DJ. Endothelial Piezo1 channels as sensors of exercise. J Physiol. 2018 Mar 15;596(6):979-984. doi: 10.1113/JP274396. Epub 2018 Jan 9.
- Li X, Han L, Nookaew I, Mannen E, Silva MJ, Almeida M, Xiong J. Stimulation of Piezo1 by mechanical signals promotes bone anabolism. Elife. 2019 Oct 7;8:e49631.
- Bratengeier C, Liszka A, Hoffman J, Bakker AD, Fahlgren A. High shear stress amplitude in combination with prolonged stimulus duration determine induction of osteoclast formation by hematopoietic progenitor cells. FASEB J. 2020 Mar;34(3):3755-3772.
- Li X, Kordsmeier J, Xiong J. New Advances in Osteocyte Mechanotransduction. Curr Osteoporos Rep. 2021 Feb;19(1):101-106.
- Chen M, Künne C, Sokol AM, Günther S, Martínez A, Fleming I, Wettschureck N, Graumann J, Weinstein LS, Offermanns S. Shear stress-induced endothelial adrenomedullin signaling regulates vascular tone and blood pressure. J Clin Invest. 2019 Jun 17;129(7):2775-2791.
- Koser DE, Thompson AJ, Foster SK, Dwivedy A, Pillai EK, Sheridan GK, Svoboda H, Viana M, Costa LD, Guck J, Holt CE, Franze K. Mechanosensing is critical for axon growth in the developing brain. Nat Neurosci. 2016 Dec;19(12):1592-1598.
- Bocchero U, Falleroni F, Mortal S, Li Y, Cojoc D, Lamb T, Torre V. Mechanosensitivity is an essential component of phototransduction in vertebrate rods. PLoS Biol. 2020 Jul 15;18(7):e3000750.
- Ro SH, Fay J, Cyuzuzo CI, Jang Y, Lee N, Song HS, Harris EN. SESTRINs: Emerging Dynamic Stress-Sensors in Metabolic and Environmental Health. Front Cell Dev Biol. 2020 Dec 3;8:603421.
- Parmigiani A, Budanov AV. Sensing the Environment Through Sestrins: Implications for Cellular Metabolism. Int Rev Cell Mol Biol. 2016; 327():1-42.
- Wang Y, Zhao W, Shi J, Wang J, Hao J, Pang X, Huang X, Chen X, Li Y, Jin R, Ge Q. Intestinal microbiota contributes to altered glucose metabolism in simulated microgravity mouse model. FASEB J. 2019 Sep;33(9):10140-10151.
- Prasad B, Grimm D, Strauch SM, Erzinger GS, Corydon TJ, Lebert M, Magnusson NE, Infanger M, Richter P, Krüger M. Influence of Microgravity on Apoptosis in Cells, Tissues, and Other Systems In Vivo and In Vitro. Int J Mol Sci. 2020 Dec 9;21(24):9373.
- Monti N, Masiello MG, Proietti S, Catizone A, Ricci G, Harrath AH, Alwasel SH, Cucina A, Bizzarri M. Survival Pathways Are Differently Affected by Microgravity in Normal and Cancerous Breast Cells. Int J Mol Sci. 2021 Jan 16;22(2):862.
- Pagano AF, Brioche T, Arc-Chagnaud C, Demangel R, Chopard A, Py G. Short-term disuse promotes fatty acid infiltration into skeletal muscle. J Cachexia Sarcopenia Muscle. 2018 Apr;9(2):335-347.
- D’Lima DD, Fregly BJ, Patil S, Steklov N, Colwell CW Jr. Knee joint forces: prediction, measurement, and significance. Proc Inst Mech Eng H. 2012 Feb;226(2):95-102.
- D’Lima DD, Steklov N, Patil S, Colwell CW Jr. The Mark Coventry Award: in vivo knee forces during recreation and exercise after knee arthroplasty. Clin Orthop Relat Res. 2008 Nov; 466(11):2605-11.
- Collins AT, Kulvaranon ML, Cutcliffe HC, Utturkar GM, Smith WAR, Spritzer CE, Guilak F, DeFrate LE. Obesity alters the in vivo mechanical response and biochemical properties of cartilage as measured by MRI. Arthritis Res Ther. 2018 Oct 17;20(1):232.
- Momken I, Stevens L, Bergouignan A, Desplanches D, Rudwill F, Chery I, Zahariev A, Zahn S, Stein TP, Sebedio JL, Pujos-Guillot E, Falempin M, Simon C, Coxam V, Andrianjafiniony T, Gauquelin-Koch G, Picquet F, Blanc S. Resveratrol prevents the wasting disorders of mechanical unloading by acting as a physical exercise mimetic in the rat. FASEB J. 2011 Oct;25(10):3646-60.
- Joshi T, Singh AK, Haratipour P, Sah AN, Pandey AK, Naseri R, Juyal V, Farzaei MH. Targeting AMPK signaling pathway by natural products for treatment of diabetes mellitus and its complications. J Cell Physiol. 2019 Aug;234(10):17212-17231.
- Ha TKQ, Pham HTT, Cho HM, Tran VO, Yang JL, Jung DW, Williams DR, Oh WK. 12,23-Dione dammarane triterpenes from Gynostemma longipes and their muscle cell proliferation activities via activation of the AMPK pathway. Sci Rep. 2019 Feb 4;9(1):1186.
- Kim N, Kang MS, Nam M, Kim SA, Hwang GS, Kim HS. Eicosapentaenoic Acid (EPA) Modulates Glucose Metabolism by Targeting AMP-Activated Protein Kinase (AMPK) Pathway. Int J Mol Sci. 2019 Sep 25;20(19):4751.
- Popkin BM, Gordon-Larsen P. The nutrition transition: worldwide obesity dynamics and their determinants. Int J Obes Relat Metab Disord. 2004 Nov;28 Suppl 3:S2-9.
- Lee W, Nims RJ, Savadipour A, Zhang Q, Leddy HA, Liu F, McNulty AL, Chen Y, Guilak F, Liedtke WB. Inflammatory signaling sensitizes Piezo1 mechanotransduction in articular chondrocytes as a pathogenic feed-forward mechanism in osteoarthritis. Proc Natl Acad Sci U S A. 2021 Mar 30;118(13):e2001611118.
- Asher A, Tintle NL, Myers M, Lockshon L, Bacareza H, Harris WS. Blood omega-3 fatty acids and death from COVID-19: A pilot study. Prostaglandins Leukot Essent Fatty Acids. 2021 Jan 20;166:102250.
- Kim HS. Do an Altered Gut Microbiota and an Associated Leaky Gut Affect COVID-19 Severity? MBio DOI: 10.1128/mBio.03022-20
- https://www.washingtontimes.com/news/2021/mar/10/jay-bhattacharya-stanford-doctor-lockdowns-single-/
- The World Obesity Organisation. Covid and Obesity: the 2021 Atlas. March 2021. https://www.worldobesityday.org/assets/downloads/COVID-19-and-Obesity-The-2021-Atlas.pdf
- O’Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis. J Am Heart Assoc. 2021 Feb;10(5):e019259.
- Ruberti OM, Telles GD, Rodrigues B. Stress and physical inactivity: two explosive ingredients for the heart in COVID-19 pandemic times. Curr Cardiol Rev. 2021 Jan 25. doi: 10.2174/1573403X17666210126103204.
- Kirwan R, McCullough D, Butler T, Perez de Heredia F, Davies IG, Stewart C. Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. Geroscience. 2020 Dec;42(6):1547-1578.