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make us susceptible, especially susceptible and vulnerable look at the proportion of testing relative to our population,
to this are the same things that functional medicine we’ve actually been testing less in terms of percent of the
addresses, but it’s just not addressed well in allopathic population getting tested, and our percent positive in
medicine. many of our regions tend to be higher than a lot of other
So that’s been one of the themes of a lot of my talks on countries. In my first interview I made a prediction that
this crisis, is what has COVID illuminated for us in terms we would be uniquely vulnerable to this contagion because
of our vulnerabilities, and how treatment and prevention of our general health and this was when the US only had
fits the functional medicine model. And, in fact, all of the four or five cases.
risk factors that put you at severe risk for an adverse One of the things I said is that we are particularly
response in COVID infection are the same things that vulnerable to a virus like this, and this is even from what
functional medicine is focusing on to reduce risk for other we knew at that time about the virus. We started hearing
chronic illness. already about the cytokine storm, and people going into
respiratory failure. One of the things that becomes very
IMCJ: From a functional medicine perspective, what do clear is chronic low-grade inflammation makes you
you think are the items that need to be addressed? exceptionally susceptible to this. That’s one of the features
of being older as well.
Mr Krishnan: It’s becoming more clear who’s most That’s one of the reasons why the elderly population is
vulnerable for this particular virus. When it first came on, also susceptible to it because of chronic low-grade
we thought of it as a respiratory virus, which is not inflammation and the leakier the gut tends to be. One of
uncommon because of the class of virus that it is, the the first things I said on that interview is my big concern
coronavirus class. Positive-sense RNA. It clearly infected is when this virus makes its way here in large part to North
pulmonary epithelial cells, and the predominant symptom America, we are especially susceptible to it because of our
was coughing and then people going into respiratory state of health because we have a younger population with
failure. this kind of chronic low-grade inflammation than you
Now we know a little bit better that the infection is a typically see in more older populations in other countries.
lot more systemic. It’s more so a blood infection than We have a higher percentage of people who are in
anything else. The respiratory side may be secondary to their 30s and 40s with heart disease, diabetes, and so on
the primary infection, which could be in the gut or the than in many other countries in the world. We tend to be
blood, the circulatory system. Now, when you start looking more unhealthy in that respect, which makes us much
at the people that are the most vulnerable to this, take more vulnerable. But one of the silver linings, and I’ve
diabetes for example, If you are diabetic, you have seven mentioned this a lot of times in my interviews, is this virus
times increased risk of dying from COVID than the non- has illuminated for us what our vulnerabilities are. The
diabetic. good news is the majority of people still get very mild
If you have heart disease, you have four times response if not completely asymptomatic response, and
increased risk, and that is not completely dependent on then some people battle this for months.
age, either. If you are diabetic and older, then the risk goes There’s a big discrepancy here between how your
up even more. But you could be in your 40s and be body responds to it based on your existing status, and it
diabetic and have seven times increased risk of dying than seems pretty clear now that chronic low-grade
somebody who’s 40 and non-diabetic. inflammation and vascular disease are really the big risk
Conditions associated with chronic low-grade factors, and the gut and the microbiome and the leakiness
inflammation and vascular dysfunction (example: in the gut plays such a big role in that.
hypertension, diabetes, obesity, CVD) create the highest
risks for adverse response to the virus. This means that we IMCJ: Which is an important reason that we need to
need to address chronic low-grade inflammation and improve our gut health, whether that’s through probiotics,
cardiovascular health to reduce vulnerability diet, prebiotics, whatever it might be, but eliminating that
leaky gut. What would you say to that?
IMCJ: Do you think that because of our lifestyle and a
higher inflammatory diet, resulting in increased cases of Mr Krishnan: Absolutely, depending on the type of strain,
heart disease and diabetes than other parts of the world you can absolutely eliminate leaky gut. We’ve shown that
are we seeing more cases here? Or are we just testing in publications. That’s one of the reasons why we work
more? very closely with the spore-based probiotics. They’re the
ones, so far, that have been shown to be able to actually
Mr Krishnan: I think that has impacted us more. Testing close up those tight junctions, actually rebuild the mucosal
more will give you more cases, but when you look layer, and actually increase the diversity within the
proportionately, our per capita infection rate tends to be microbiome, especially the growth of protective strains of
higher than many other developed nations... When you bacteria.

Krishnan—Viewpoints Integrative Medicine • Vol. 19, No. S1 69