Covid-19 from Up-Close

The Story of Covid-19

Over the past several months, there have been many guesses about a new virus, Sars-Cov-2 (SC2). Research and some publications (academic, pre-prints, and blogs) have suggested various hypotheses. The prominent issue to be explained properly was the puzzle of hypoxia (lack of sufficient oxygen) that manifested in an unusual way: often the sick were still chatting away happily while their oxygen saturation dropped to dangerous lows. This later came to be known as happy hypoxics because with the level of hypoxia they showed, they should have been incomprehensible or unconscious, and not be walking and chatting with doctors or with friends on the phone. Yet they were and this was never seen before.

While most medical facilities rushed to judgment and labelled the hypoxia as ARDS and caused by pneumonia, the symptoms didn’t quite fit the diagnosis. Pneumonia usually starts as unilateral viral, taking on one of the lungs and not both. Later it may become bilateral as it turns to bacterial. However, regardless whether it is viral or bacterial, cough with heavy phlegm and sputum is strongly associated with pneumonia. Yet in the case of Covid-19, the cough is unproductive and dry. It is nothing like pneumonia.

ARDS seemed more on target with the symptoms, except for the big difference that in the case of ARDS, the patient is not talking, walking, happy hypoxic, but is barely conscious. So nothing we knew as a “disease” fit the bill as Covid-19 took hold. Ventilators clearly weren’t helping. Most patients on ventilators died–some hospitals reporting an astronomical, over 80%, death-rates of those placed on ventilators.

There were lots of discussions about hemoglobin and how the virus somehow takes hemoglobin out of the red blood cells; discussions about too many red blood cells plugging up the whole body and circulation, and other similar points of views. Then, all of a sudden some doctors discovered that many patients suffered blood clotting problems. This article still discusses lung problems and coagulation as two different problems. This article discusses the clotting in the lungs as pulmonary embolism, as if it were distinct from Covid-19. And here we can see the first signs of actual understanding. Indeed, when we talk about coagulation of the blood, we need to look at what is causing the blood clotting, where in the body, and how. Crucially, kidney failure was starting to become frequent and dialysis machines started to clog up with the platelets, which formed the blood clots. What was happening?

Endothelial Damage

Watch the video from MedCram, Covid-19 discussion from YouTube #75. This lecture summarizes a lot of knowledge (74 previous lectures) so if you are interested to learn more, sign up at; it is free. Here is this lecture on MedCram itself. MedCram offers continuing education credits for doctors as well, so if you didn’t know it up until now, this is time for you to check it out.

Covid-19’s Connection to Metabolic Disease

I now understand why most people who die from Covid-19 have metabolic disease.  Metabolic disease is a catch-all term that incorporates a number of health conditions associated with high levels of blood glucose and insulin. Before you think only of type 2 diabetes, I must call your attention to the following conditions, all encapsulated in the definition of metabolic disease: conditions that affect the breakdown of amino acidscarbohydrates, lipids, as well as mitochondrial diseases; basically any condition that affects the parts of the cells that produce the energy. In the case of Covid-19, we need to focus on one of these: carbohydrate metabolism. Why this is so will become clear later. The following are metabolic diseases that fall into this category of carbohydrate metabolism:

  • Type 2 diabetes
  • Insulin resistance
  • Prediabetes
  • Cardiovascular disease
  • Stroke
  • Cancer–not all but most
  • Obesity–not all obese are metabolically ill but about 80% are
  • TOFI (Thin Outside Fat Inside)

As hospital findings indicate, the most serious Covid-19 cases are presented by people who have one or more of the above underlying conditions. COPD and asthma are also on the underlying conditions list but later evaluations show fewer negative consequences. What is the connection of metabolic disease to Covid-19?

Covid-19 is an Endothelial Disease

The endothelium is a single-layer cell wall that lines the inside of every blood vessel.

The role of the endothelium is many fold, one of which is to protect the lumen (the area where the blood flows in the blood vessel) and also to permit certain substances through to the muscles. What muscles? The blood vessel itself. Few people realize that blood vessels are muscles. But you can envision it as a muscle, after all, if your drink caffeine, it is a vasoconstrictor, it constricts your blood vessels, and that’s only possible if the blood vessels are muscles. As muscles, blood vessels have many layers that ensure proper constriction or dilation when necessary, as well as food supply.

On top of the endothelium is a layer of hair-like substance (facing inward where the blood flows), which is the glycocalyx. It is a very slippery “hair” (cilia) that keeps the blood flowing in one direction. The blood flows in the lumen–inside the blood vessel lined with the endothelium and the glycocalyx. The glycocalyx is an essential protective layer that forms a barrier between whatever flows in the blood and the endothelial wall.

Glucose-Connection to Glycocalyx Damage

Glucose damages the glycocalyx, not only from long-term high carbohydrate consumption, but even from a single large glucose meal.

Eating lots of glucose in just one meal or in most meals, as in a typical American diet, means eating sugar and all sweetened foods, grains and starches (they are extremely high in glucose), most fruits, juices and soft drinks. This creates a large glucose load in the blood. Consumed just time to time or regularly with every meal, high-glucose-carbohydrates damage the glycocalyx–the glycocalyx can literally be destroyed. Most processed foods contain sugar, grains, and starches, so they also meet this category even if they are canned meat or vegetables.

Damaged Glycocalyx = Damaged Endothelial Cells

When the glycocalyx is damaged, all barriers to the endothelium are removed, allowing damage to the endothelium by anything in the blood, including pathogens, such as viruses. In this case, as the video from MedCram shows, SC2 viruses wee found in the endothelial cells. This then is the cause of the problem.

People with metabolic disease associated with carbohydrates have higher blood glucose levels than they should have, which damages the glycocalyx. These metabolic conditions are on the bullet-points above. Once the glycocalyx is damaged, it can take 8-12 hours for the glycocalyx to recover. So if one eats a carbs meal, such as a bowl of rice or beans, or a couple of slices of bread, or a pasta dish, or a slice of cake, or a glass of fruits juice or soda, or a large serving of tropical fruits, etc., that person causes an open vulnerable time period of 8-12 hours during which time SC2 virus can easily attack the endothelial cells.

For people with metabolic diseases, which come with high blood glucose, the glycocalyx is permanently damaged and damage to the endothelium is possible 24/7. To get a great understanding about the connection of the endothelium damage and clotting, watch this video. He doesn’t mention the glycocalyx, I suppose for the sake of simplicity.

The Clotting Factor

SC2 virus in the endothelial cells is bad news, because of the cascade of events that it initiates. Right below the endothelial cells at the layer between the endothelium and the muscle we find the von willebrand factor, which is on guard in case the endothelium is damaged, and it signals for clotting factors. The reason for this is clear: damaged endothelial wall can lead to excessive bleeding, so it is important to clot the damage as fast as possible. This is not any different from when you cut your finger.

Clotting factors, such as d-dimer, fibrin, prothrombin (see the video on clotting and endothelium above) and others (these are found in in Covid victims, usually in huge excess amounts) cause thrombosis (blood clots that are not in the main artery but anywhere else, including small blood vessels and capillaries) in the lungs capillaries and blood vessels, because the virus attacks the endothelial cells in the lungs, causing possible bleeding. Tons of capillaries in the lungs get thrombotic as a result of the endothelial damage. This is similar to pulmonary embolism (PE), except that whereas PE is one large blood clot, which can often be removed, in this case there are blood clots by the dozen or by the hundreds, in the capillaries of the lungs (I refer you back to the MedCram video on the top of the page for images on this). These tiny blood clots form tons of thromboses, preventing oxygenation. The lungs, as some other organs, try to find ways around the problem of  closed-off capillaries by creating new capillaries. So the thromboses induce the growth of many new capillaries to bypass those plugged up with viscous blood. But there is scarcity of space in the lungs!

The Outcome

All through this, the lungs cannot exchange O2 and CO2 because the capillaries are closed off by thrombosis and as new capillaries form, the lungs “fill up” with these new capillaries. Ventilators don’t help because the problem is lack of blood vessels through which oxygen exchange could take place. So no matter how much the lungs are pressed in and out and filled with oxygen, while oxygen goes in and out of the lungs, it doesn’t go in and out of the blood of the patient. There is no oxygen movement in the blood. This is what leads to fatality.


Prevention is likely possible. It is never too late to do your best to try to prevent a bad outcome. The most important thing appears to be the health of the glycocalyx to prevent the endothelium from damage and therefore the possibility of being attacked by the virus. To ensure that your glycocalyx is in great shape, make sure you keep your diet healthy and low in carbohydrates.

A healthy diet means different things to different people, and under normal circumstances we can just shrug our shoulders and accept our differences. However, if one thing Covid-19 has taught us, it is that metabolic health means a lot more than long-term-managed type 2 diabetes or the loss of excess weight. Metabolic diseases associated with carbohydrates are preventable. Those that are already established are possible to reverse and very advanced forms are possible to put to remission. Learn how to reverse metabolic disease by the ketogenic diet here.

To reduce or prevent damage to the glycocalyx and thereby to the endothelium, we must stop eating excess carbs! We most certainly must stop eating sugar, grain, starch, fruits that are naturally high in sugar, fruit juices (even from the fresh fruit picked from our own trees), soft drinks, and processed foods.

It is unclear to me how much damage industrially processed vegetable and seed oils may cause to the glycocalyx. From similar endothelium damage occurring in cardiovascular heart diseases leading to heart attacks, we know that processed oils are highly oxidized rancid oils that cause damage to the artery walls. Since they are damaging to the endothelium, likely they cause damage to the glycocalyx as well. This means we must stop all processed foods because they always contain some form of sugar and are made with these bad oils.

There has never ever been a better time to start on a low carbohydrate diet!

My Thoughts

This terrible disease will most certainly be still throwing some curve balls at us as time passes. I will keep on updating as time allows. This should provide enough coverage and understanding to help you see what you need to do to improve your chances in case you catch the bug. You have a chance to come out alive.

Comments, as always, are welcome and are moderated for appropriateness


About Angela A Stanton, Ph.D.

Angela A Stanton, PhD, is a Neuroeconomist focusing on chronic pain--migraine in particular--physiology, electrolyte homeostasis, nutrition, and genetics. She lives in Southern California. Her current research is focused on migraine cause, prevention, and treatment without the use of medicine. As a forever migraineur from childhood, her discovery was helped by experimenting on herself. She found the cause of migraine to be at the ionic level, associated with disruption of the electrolyte homeostasis, resulting from genetic variations of all voltage dependent channels, gates, and pumps (chanelopathy) that modulate electrolyte mineral density and voltage in the brain. In addition, insulin and glucose transporters, and several other variants, such as MTHFR variants of B vitamin methylation process and many others are different in the case of a migraineur from the general population. Migraineurs are glucose sensitive (carbohydrate intolerant) and should avoid eating carbs as much as possible. She is working on her hypothesis that migraine is a metabolic disease. As a result of the success of the first edition of her book and her helping over 5000 migraineurs successfully prevent their migraines world wide, all ages and both genders, and all types of migraines, she published the 2nd (extended) edition of her migraine book "Fighting The Migraine Epidemic: Complete Guide: How To Treat & Prevent Migraines Without Medications". The 2nd edition is the “holy grail” of migraine cause, development, and prevention, incorporating all there is to know. It includes a long section for medical and research professionals. The book is full of academic citations (over 800) to authenticate the statements she makes to make it easy to follow up by those interested and to spark further research interest. It is a "Complete Guide", published on September 29, 2017. Dr. Stanton received her BSc at UCLA in Mathematics, MBA at UCR, MS in Management Science and Engineering at Stanford University, PhD in Economics with dissertation in neuroscience (culminating in Neuroeconomics) at Claremont Graduate University, fMRI certification at Harvard University Medical School at the Martinos Center for Neuroimaging for experimenting with neurotransmitters on human volunteers, certification in LCHF/ketogenic diet from NN (Nutrition Network), certification in physiology (UPEN via Coursea), Nutrition (Harvard Shool of Public Health) and functional medicine studies. Dr. Stanton is an avid sports fan, currently power weight lifting and kickboxing. For relaxation (yeah.. about a half minute each day), she paints and photographs and loves to spend time with her family of husband of 45 years, 2 sons and their wives, and 2 granddaughters. Follow her on Twitter at: @MigraineBook, LinkedIn at and facebook at
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4 Responses to Covid-19 from Up-Close

  1. Mia Tee says:

    Thanks for this, I wondered how this process works with those (1 in 10 people to be precise) who have been affected by covid symptoms on a long term basis I.e 3-4+ months. When oxygen levels are reading at 100% and vitals mostly all normal so they’re not quite classed as ill enough to be admitted to hospital in the majority of cases. If the oxygen levels are all normal, it’s a mine field.

    Liked by 1 person

    • Mia most people don’t have 100% Oxygen Saturation even when fully healthy. There is also an age variant to this–the older one gets, the lower oxygen saturation is considered to be within normal ranges. An oxygen saturation over 90% is considered normal for all age groups. Below 90% there are variants.

      In this article I refer to happy hypoxics whose oxygen saturation may be as low at 50% and are still happily chatting on their phones. It refers to that sort of an oxygen saturation and not light drop. They have mostly normal vitals but their oxygen saturation is very low. So the only sign of trouble is the low O2 SAT.


  2. Roald Michel says:

    Shared this immediately on my FB page 😈

    Liked by 1 person

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