Antibiotic Resistant Infections: A growing threat

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  • At least 1.27 million deaths per year are directly attributable to AMR (Antimicrobial Resistance), according to global AMR estimates released earlier this year by IHME (Institute of Health Metrics and Evaluation) and Global Research on Antimicrobial Resistance (GRAM) Project partners.
     
  • The deadliest pathogen-drug combination globally was methicillin-resistant Staphylococcus aureus (MRSA), which caused more than 100,000 deaths attributable to AMR in 2019.
     
  • MRSA can infect cuts or scrapes in the skin and then be passed through skin-to-skin contact or through items such as towels or clothing that have touched the infected skin.

There are several pathways converging on Anti-Microbial Resistance.

  • Misuse and Overuse of antibiotics in raising meat, farmed fish, dairy, poultry and eggs
  • Excessive use of antibiotics in Medicine
  • Lack of clean water and sanitation in many poor countries
  • Poor infection and disease prevention and control in health-care facilities and farms
  • Poor access to quality, affordable medicines and vaccines
  • Lack of awareness and knowledge

Emerging resistant strains include sexually transmitted infections (gonorrhea, syphilis, chlamydia), MRSA, tuberculosis, several bacteria that cause pneumonia, urinary tract infections and food poisoning.

Viral infections are also demonstrating antibiotic resistance including HIV (10% of cases in the majority of monitored countries in Africa, Asia and Latin America).

Malaria is also developing drug resistance and as global warming pushes this disease further north, soon greater parts of USA will be experiencing this mosquito vectored disease.

Drug resistant fungal infections (especially Candida which represents a major threat to immunocompromised individuals, especially in the hospital setting) are becoming widespread.

Antibiotic resistance in animal husbandry presents unique challenges.

Antibiotic resistance is of great public health concern because the antibiotic-resistant bacteria associated with the animals may be pathogenic to humans, easily transmitted to humans via food chains, and widely disseminated in the environment via animal wastes. These may cause complicated, untreatable, and prolonged infections in humans, leading to higher healthcare cost and sometimes death.

One of the problems with the RWA designation (Raised Without Antibiotics) is that it does not distinguish between overuse (used for prevention, growth and output) and use to treat infections. There should be a category of RWA that indicates that antibiotics are used only to treat illness in animals, not to prevent infections or foster growth.

RWA programs are intended to supply customers, such as restaurants, grocers and other food service establishments, with meat, eggs, and dairy products that can be labeled as having never had exposure to antibiotics.

Research in animal husbandry has demonstrated that pork, beef, chicken, dairy, and eggs raised without preventive antibiotics following simple sanitary protocols can decrease total cost in the long run. (Taking into account costs of antimicrobial resistance) Yet farmers continue to utilize antibiotics routinely to prevent rather than treat infections, due to habit, marketing (pharmaceutical industry) and fear of change.

This raises the issue of free-range economics vs raising animals in crowded environments. Regenerative agricultural practice incorporates free-range animal husbandry into crop management in a manner that utilizes animal waste for fertilizer instead of fossil-based nitrogen sources (reducing carbon foot print and creating rather than destroying soil), and eliminates crowded conditions, decreasing risk of infection. In addition there are many other potential approaches to help solve the problem of AMR.

Phytochemicals added to chicken feed represents a possible alternative to antibiotics to control antibiotic resistance in poultry.

Altering simple practices in the dairy industry (changing the rate at which a slurry tank is emptied) can delay the proliferation of multidrug-resistant bacteria.

There are many potential approaches to animal husbandry that can mitigate the growing problem of AMR.

The use of antibiotics to enhance profitability margins in the animal production industry is still practiced worldwide. Although many technical and economic reasons gave rise to these practices, the continued emergence of antimicrobial resistant bacteria is furthering the need to reduce the use of medically important antibiotics. This will require improving on-farm management and biosecurity practices, and the development of effective antibiotic alternatives that will reduce the dependence on antibiotics within the animal industry in the foreseeable future. A number of approaches are being closely scrutinized and optimized to achieve this goal, including the development of promising antibiotic alternatives to control bacterial virulence through quorum-sensing disruption, the use of synthetic polymers and nanoparticles, the exploitation of recombinant enzymes/proteins (such as glucose oxidases, alkaline phosphatases and proteases), and the use of phytochemicals.

Studies investigating various alternatives to antibiotics use in livestock show promising results. These alternatives include the application of bacteriophages and phage derived peptidoglycan degrading enzymes, engineered peptides, egg yolk antibodies, probiotics, prebiotics and synbiotics, as well as quorum quenching molecules

Simple sanitation techniques in raising poultry can achieve benefit without the use of prophylactic antibiotics.

Keeping strict biosecurity in segregation, traffic control, cleaning, and disinfection, helps prevent a large proportion of harmful bacteria and viruses from entering poultry barns (Segal, 2013). Apart from good management practices, there are many alternative approaches proposed and explored by researchers worldwide to overcome bacterial infections in birds.

Likewise, eliminating antibiotics from pig feed does not reduce growth measured at the end of finisher stage, and eliminates the cost of antibiotics in the feed.

At the consumer level, purchase animal products raised without prophylactic antibiotics. This will protect your family and send a message to the marketplace. The more we demand food raised without preventive antibiotics, the more producers will be forced to change old-unsafe habits.

Buying meat, poultry, dairy and eggs from local farmers that do not utilize preventive antibiotic usage and practice regenerative agriculture, is a great way to shift the marketplace towards a safer and more sustainable food system that improves health and safety while addressing loss of soil and carbon footprint.

If you prefer watching documentaries there are several that address issues related to regenerative agriculture. Here are a few:

https://www.thepollinators.net/

https://www.biggestlittlefarmmovie.com/

https://www.bbc.com/future/bespoke/follow-the-food/

https://www.sacredcow.info/about-the-film

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins. (Such as a Berkey or reverse osmosis filter)
  12. HEPA filters or the home-made version (Corsi-Rosenthal box) used in your home or workplace can reduce circulating viral load by 80%. This works for any respiratory virus transmitted by aerosol and this winter we have the triple threat of RSV, Influenza, and SARS-CoV-2. It also decreases indoor air pollution.
  13. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

3 Respiratory Viruses Threaten World Health this winter

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Winter approaches with a perfect storm of 3 respiratory viruses, increased indoor activity, dry spaces, and holiday gatherings. The 3 viruses already filling many hospitals (including children’s hospitals) include RSV (Respiratory Syncytial Virus), Influenza, and SARS-CoV-2.

Respiratory viruses spread by aerosol typically enter through the nose and throat. Dry nasal and oral-pharyngeal mucosa (the lining of the nose and throat) presents an ideal incubator for respiratory viruses. With winter comes drier indoor environments created by heating systems.

A recently published study concluded:

Indoor conditions, particularly indoor RH (relative humidity) modulate the spread and severity of COVID-19 outbreaks.

The sweet spot was between 40% and 60% humidity to minimize spread and severity of infection.

Here is a picture of the temperature and humidity monitor in my home office.

Note that while outdoor humidity is 55%, indoor humidity is only 34%, short of the “ideal” range for decreased viral transmission and severity. We have a humidifier in our bedroom where the RH is higher.

In addition to a bedroom humidifier we have several HEPA filters dispersed throughout the house. HEPA filters can decrease aerosol (viral load) by 80% or more as can the homemade Corsi-Rosenthal box. HEPA filters and the Corsi-Rosenthal Box also significantly reduce indoor air pollution, potentially protecting us from not only respiratory disease but also heart attacks, strokes, dementia and cancer.

As the winter approaches consider protecting your family and friends from RSV, Influenza, and COVID-19 by utilizing a humidifier and free standing HEPA filters. Improving indoor air quality will have many health benefits.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins. (Such as a Berkey or reverse osmosis filter)
  12. HEPA filters or the home-made version (Corsi-Rosenthal box) used in your home or workplace can reduce circulating viral load by 80%. This works for any respiratory virus transmitted by aerosol and this winter we have the triple threat of RSV, Influenza, and SARS-CoV-2. It also decreases indoor air pollution.
  13. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

The argument for cattle grazing and meat consumption: COP27

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The 2022 United Nations Climate Change Conference or Conference of the Parties of the UNFCCC, more commonly referred to as COP27, is the 27th United Nations Climate Change conference and is being held from 6 November until 18 November 2022 in Sharm El Sheikh, Egypt.

The summit presented an opportunity for nutritionist and healthy food advocate Diana Rogers to offer an alternative to the false narrative so prevalent today regarding beef, global warming, and nutrition.

The false narrative states that methane released by raising cattle is a major contributor to global warming and meat is unhealthy. This narrative diverts attention from the real source of global warming, fossil fuels. Importantly this narrative ignores the importance of meat consumption for human health as well the importance of ruminant grazing for soil regeneration as well as economic and food stability for many poor people. Lastly it ignores the contribution of properly raised cattle, lamb and other animal food sources to carbon sequestration.

By most estimates, the number of ruminants roaming our plains and forests before the industrial era was equal to the number of wild and domestic ruminants in the US today.

Global warming was not a problem before industrialization. This simple fact should belie the false narrative.

Diana Rogers has been a champion for honest science in this debate. She is the only nutritionist to present information at the conference. She has recently posted on twitter the slides presented at the global COP27.

Here are some of her slides that speak for themselves.

Well managed cattle when raised in an integrative fashion with crops in a process called regenerative agriculture:

  • sequester carbon
  • regenerate soils
  • provide high quality nutrition to an increasingly diseased and nutrient deficient population
  • Reduce the need for fossil fuels and fossil-based fertilizer, providing natural fertizlizer

Mono-agriculture, which predominates US farmland (90%)

  • destroys soil, killing essential microbes and converting soil to dirt
  • converts cropland to desert contributing to air pollution (dust storms), soil erosion and floods
  • releases carbon into the atmosphere during tillage
  • utilizes Roundup-ready crops that are sprayed with roundup before harvest (carcinogenic, endocrine disruptor which contaminates our food and water)
  • consumes large amounts of fossil fuel and fossil-based fertilizer creating a large carbon footprint.
  • Kills more innocent bystander animals directly (during tillage, planting, and harvest) and indirectly (habitat destruction), then the number of animals slaughtered for human consumption (are cattle more worthy of protection than rabbits, squirrels, mice, birds, snakes etc., all of which are killed by mono-agriculture practices?)
  • Depletes our soil, and therefore our food, of nutrients, reducing the nutrient content of vegetables and fruits. (example: 8 oranges today have the same nutrients as 1 orange 100 years ago)

Animal protein offers twice the bioavailability of plant protein.

Malnutrition is rampant throughout the world.

This affects health, brain development and educational achievement.

Livestock contribute to food security.

It is time for the narrative about eating and raising animal sources of protein to change. We need to produce rather than destroy soil, enhance rather than degrade the nutrient value of crops, sequester rather than release carbon, utilize ruminant waste for fertilizer instead of fossil based fertilizer, and provide our children and adults with nutrient dense healthy food that includes animal sources of protein.

The cow-methane narrative ignores much of science and diverts our attention from the source of global warming, the burning of fossil fuels.

To learn more about this topic visit the Global Food Justice Alliance

The Global Food Justice Alliance advocates for the right of all people to choose nutrient-dense foods such as meat, milk, and eggs, which are critical for nutritious, environmentally sustainable, and equitable food systems that can sustain both human life and the planet.

Here are some of the bullet points from Diana Rogers’ presentation at COP27

  • Many are claiming meat is unhealthy, unsustainable, unnecessary and unethical, but are these claims justified? Are we looking at livestock agriculture in a holistic way? What strong evidence do we have to prove this?
  • Or are policymakers and others pushing for the removal or dramatic reduction in livestock suffering from “carbon tunnel vision”? Are they failing to account for the value meat plays to human health, rural economies, and overall ecosystem function?
  • Worldwide, 1 in 2 children and 2 in 3 women have at least one micronutrient deficiency, wreaking havoc on immune systems, hindering growth and development, and limiting human potential.
  • These deficiencies are not limited to low- and middle-income countries. Iron deficiency alone impacts 1 in 5 women in the US, where we’re told to eat less meat, which is the best source of iron.
  • The leading micronutrient deficiencies are: iron, zinc, folate, vitamin A, vitamin D, and B12. As many as 40% of children and 70% of women have multiple deficiencies at the same time. Animal-sourced foods are the only or best source of all those above except folate (which is found in liver, but plant-based foods like lentils are also a good source).
  • If we are to discuss a “climate friendly diet”, we need to consider not just “emissions” but the nutritional value of the food per serving (not per calorie), because a further shift away from meat will do more harm, especially to women and children.
  • The evidence against meat for health reasons is based on shaky science. There are no experimental studies showing meat causes harm, only associations, but we know typical meat eaters also tend to partake in other unhealthy behaviors like smoking and drinking. When accounting for these factors, red meat has not been found to cause ill health.
  • When it comes to processed meat, the science is also not significant. Your overall risk of getting colon cancer is 5.6% and eating 5 slices of bacon every single day for your whole life would raise your risk to 6.6%. This is not statistically significant. However, the media reports this as a 20% increase, which is misleading to consumers.
  • We only have one experimental study looking at meat vs. less meat, which was done in Kenyan school children. It proved that adding meat increased their academic scores, their physical ability, and their behavior.
  • Because livestock can “up-cycle” nutrient poor food (food scraps, waste from the plant-protein industry, and grains) into protein, iron, B12, and other critical nutrients, they are a net win for our food system.
  • Livestock are less susceptible to drought or extreme weather.
  • 12% of the world’s population rely solely on livestock for their livelihood.
  • Women in ½ the countries worldwide are unable to own land, but in many cases, they can own livestock, improving gender equality and household nutrition.
  • Plus, most of our agricultural land is too dry, brittle, or rocky to crop, but livestock thrive on this marginal land.
  • Food choice is a privilege. Those with the means to push away nutritious food like meat should not be creating policies limiting access to nutrients in meat, which is also a culturally appropriate food to most. This is moral and cultural imperialism.
  • We need a lot more recognition that livestock can provide critical ecosystem function and micronutrients.

Check out the work of Diana Rogers

info@sacredcow.info
sustainabledish.com

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins. (Such as a Berkey or reverse osmosis filter)
  12. HEPA filters or the home-made version (Corsi-Rosenthal box) used in your home or workplace can reduce circulating viral load by 80%. This works for any respiratory virus transmitted by aerosol and this winter we have the triple threat of RSV, Influenza, and SARS-CoV-2. It also decreases indoor air pollution.
  13. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Paxlovid is a winner, but lifestyle changes are essential to mitigate Covid risk.

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This discussion was originally posted before PAXLOVID WAS AVAILABLE. The title was originally Lifestyle More Effective than Drugs.

But now we have Paxlovid. Paxlovid is very effective in reducing morbidity and mortality associated with Covid-19 infection but also appears to reduce risk of Long Covid. Standard dosing: PAXLOVID two 150-mg tablets of nirmatrelvir, one 100-mg tablet of ritonavir twice daily for 5 days.

Dose adjustments are necessary for certain medical conditions and there are many drug interactions that should be considered. But do not let that discourage you from asking your provider to prescribe this drug for an acute Covid infection. This is a truly effective drug. It decreases morbidity and mortality as well as risk for Long Covid.

The results of a randomized placebo controlled clinical trial in high risk individuals has been published in the NEJM. The study was done just when Omicron hit. The study demonstrated an 89% reduction of hospitalizations and deaths by day 28 (absolute reduction of 6.2/100) with ZERO deaths in the Paxlovid group (7 in the placebo group). Paxlovid also had LESS side effects than placebo.

Another study from Israel demonstrated equally impressive results as shown here.

In addition, a study from the VA has looked at longer term effects (pre-print publication, still waiting for peer review.)

The study included 9000 Paxlovid patients treated within 5 days of symptom onset during the Omicron and subvariant waves and compared the treated patients with approximately 47,000 matched controls.

There was a 26% reduction in Long Covid.

Here is a breakdown of the Long Covid Symptoms

The VA study also showed a 48% reduction of death and 30% reduction in hospitalization after the acute phase (acute phase = first 30 days) as demonstrated here.

Many drug intervention trials for treating COVID-19 early in the pandemic have been disappointing. No studies have shown benefit for hydroxychloroquine, with or without azithromycin. This topic has been covered in previous posts. Remdesivir was FDA approved based upon one study that showed reduction in duration of symptoms. The mortality rate with Remdesivir, however, did not demonstrate a statistically significant difference when compared to “usual care”. https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19

Another study published in Lancet failed to show any clinical benefit from Remdesivir.

“No statistically significant benefits were observed for remdesivir treatment beyond those of standard of care treatment. Our trial did not attain the predetermined sample size because the outbreak of COVID-19 was brought under control in China. Future studies of remdesivir, including earlier treatment in patients with COVID-19 and higher-dose regimens or in combination with other antivirals or SARS-CoV-2 neutralising antibodies in those with severe COVID-19 are needed to better understand its potential effectiveness.”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext

Likewise well designed studies of Ivermectin have shown no clinical benefit.

Monoclonal antibodies effective against early variants are no longer effective against the newer variants. So in terms of drug therapies for acute Covid infections we have Paxlovid for out patient care and dexamethasone for critically ill patients.

But we do know that certain underlying conditions such as obesity, diabetes, pre-diabetes (insulin resistance) and hypertension significantly increase risk of DEATH AND COMPLICATIONS with COVID-19. Since there are lifestyle interventions that can quickly and effectively mitigate these problems (diet, exercise, sleep, stress reduction….) now would seem like a good time to take our epidemics of obesity and diabetes in hand with aggressive lifestyle interventions to decrease the mortality rate of COVID-19 infection.

Such measures do not require expensive drugs or expensive drug trials, they simply require knowledge, guidelines and the will to implement change in our daily habits. Yet there has been little discussion about this in the media or on the part of public health officials.

Lets look at obesity in the US.

From 1999–2000 through 2017–2018, the age-adjusted prevalence of obesity increased from

30.5% to 42.4%, and the prevalence of severe obesity increased from 4.7% to 9.2%.

Click to access db360-h.pdf

The most effective tool for addressing obesity and diabetes is a very low carbohydrate diet.

Effects of the Low Carbohydrate, High Fat Diet on Glycemic Control and Body Weight in Patients With Type 2 Diabetes: Experience From a Community-Based Cohort

https://pubmed.ncbi.nlm.nih.gov/32193200/

This study was a done in a community-based program, not an academic practice setting. That is significant since it demonstrates feasibility outside of academic centers with standard community resources. The results of this study confirmed the results of many previous studies done in academic settings including better blood sugar control, reduction or elimination of diabetic medications, and significant weight loss.

“All patients following the LCHF diet who initially took
insulin had either a reduction or discontinuation of
this therapy by their healthcare provider when clinically
indicated, compared with less than a quarter of
those receiving usual care.“

In another study done in Italy, significant weight reduction (7 kg), waistline reduction (7 cm.), fat mass reduction (3.8%) and systolic blood pressure reduction (10.5 mmHg) were achieved in 3 months with a Very Low Carbohydrate diet.

Middle and Long-Term Impact of a Very Low-Carbohydrate Ketogenic Diet on Cardiometabolic Factors: A Multi-Center, Cross-Sectional, Clinical Study (https://pubmed.ncbi.nlm.nih.gov/25986079/

Nina Teicholz had an opinion piece published in the Wall Street Journal on May 30, discussing the USDA dietary guidelines that have largely ignored a massive body of evidence supporting a Very Low Carbohydrate Diet for obesity and diabetes. She cites many studies that have been ignored by the USDA dietary guidelines committee. Here is here opening statement.

“Americans with obesity, diabetes, heart disease and other diet-related diseases are about three times more likely to suffer worsened outcomes from Covid-19, including death. Had we flattened the still-rising curves of these conditions, it’s quite possible that our fight against the virus would today look very different.”

You can read the full article here:

https://www.wsj.com/articles/a-low-carb-strategy-for-fighting-the-pandemics-toll-11590811260

But think about that simple statement, THREE TIMES MORE LIKELY TO SUFFER WORSENED OUTCOMES FROM COVID-19. Yet these conditions are highly responsive to lifestyle interventions that not only mitigate obesity, insulin resistance and high blood pressure, but also enhance immune function.

More from Teicholz’s opinion piece:

“Other studies have found that dietary changes can rapidly and substantially improve cardiovascular risk factors, including conditions like hypertension that are major risk factors for worsened Covid-19 outcomes. A 2011 study in the journal Obesity on 300 clinic patients eating a very low-carbohydrate diet saw blood pressure quickly drop and remain low for years. And a 2014 trial on 148 subjects, funded by the National Institutes of Health, found a low-carb diet to be “more effective for weight loss and cardiovascular risk factor reduction” than a low-fat control diet at the end of the 1-year experiment.“

In a recent letter to the editor published in the journal METABOLISM, Dr. Casey Means points out:

A diagnosis of diabetes has been a key indicator of the severity of
COVID-19, and in this regard, the virus has relentlessly highlighted our
global Achilles heel of metabolic dysfunction, and points to a prime opportunity
to fight back.
That fight, however, is not going to be won with Clorox, Purell,
masks, or anti-IL-6 drugs. The fight will only be won through a serious
commitment to improving everyone’s foundational metabolic health,
starting with the lowest hanging evidence-based fruit: dietary and lifestyle
interventions.

Read the full letter here: https://www.metabolismjournal.com/article/S0026-0495(20)30118-9/pdf

In 2 pages the letter describes multiple benefits of better glucose control relative to COVID -19 infection and the immune system as well as reduction of factors that lead to cytokine storm (terminal event for many COVID-19 patients). The letter also discusses the benefit of reducing environmental toxins (discussed in previous posts about COVID-19 and other health problems) that would likely benefit COVID-19 patients.

Research published April 18th, 2020 found that patients exposed to
highest amount of environmental nitrogen dioxide (NO2) had increased
risk of death fromCOVID-19, and that long-term exposure to this pollutant
may be one of the most important contributors to fatality by
compounding lung inflammation [20].

Minimizing exposure to environmental
pollutants may serve a role in quelling the underlying pro-inflammatory
state that characterizes metabolic disease and COVID-19 associated
cytokine storms.

Other environmental toxins, including persistent organic pollutants
(POPs) found in air, water, and food generated from pesticides
and industrial chemicals, are also strongly implicated in the pathogenesis
of metabolic syndrome; promoting “clean living,” toxin-avoidant
strategies for patients as simple as emphasizing organic foods, home
air purification, and non-toxic home supplies could be considered, although
the clinical utility of these measures in the acute setting is unknown
[21].

In discussing the white elephant in the room he states:

What is starkly missing is the clear, simple, and strong recommendation for no added
sugar or ultra-refined carbohydrates, both of which are known drivers
of postprandial hyperglycemia and inflammation. As a medical community, we must not miss the opportunity to serve patients with straightforward, evidence-based nutritional and lifestyle strategies to assist in glycemic control.

I would encourage you to follow the link and read the 2 pages supported by multiple peer-reviewed references.

An ancestral (paleo) diet is also very effective for addressing insulin resistance, diabetes type 2 and obesity. Multiple studies have demonstrated this. Although an ancestral approach is typically low carb it is not typically ketogenic, but a ketogenic ancestral diet (high in non starchy vegetables to support the gut microbiome) can be implemented by restricting fruits to one serving of berries per day and limiting starchy vegetables.

Even without severe carbohydrate restriction, an ancestral anti-inflammatory diet will quickly address insulin resistance, type 2 diabetes, and obesity. In this study, insulin resistance was reversed in 10 days.

And another study compared an Ancestral (Paleo) diet to the Mediterranean diet in patients with ischemic heart disease AND insulin resistance (glucose intolerance or type 2 diabetes). Ancestral diet was superior to the Mediterranean diet in improving insulin sensitivity, blood sugar control and greater fat loss. Fasting blood sugars normalized in all patients on the Ancestral diet who had previously had abnormal blood sugars.

And here is a slide from one of my lectures with references on how an ancestral diet modulates immunity.

Leptin resistance, insulin resistance and obesity travel together. Here is yet another study demonstrating the effectiveness of an ancestral diet.

If you have obesity, diabetes or pre-diabetes the Very Low Carbohydrate version of the anti-inflammatory diet linked above would be the fastest and most effective intervention you can immediately employ to reduce your risk of succumbing to COVID-19. (Of course wear an N-95, follow good hygiene with hand-washing frequently, and use a HEPA filter or Corsi-Rosenthal box in your home, office, and enclosed work spaces)

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins.
  12. HEPA filters or the home-made version (Corsi-Rosenthal box) used in your home or workplace can reduce circulating viral load as discussed on this website.
  13. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Low Dose Naltrexone and Rhodiola for Long Covid?

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There is great overlap in symptoms and physiology of Long Covid and ME/CFS (Myalgic Encephalitis/Chronic Fatigue Syndrome.

Both are marked by Brain Fog, Cognitive Impairment, Post Exertional Malaise, with similar findings on studies of the immune system and the neuro-endocrine system in these conditions.

Here is a picture of organ involvement with CFS:

And here is a picture of Long Covid.

Do you notice the similarities and overlap?

The theories/clinical findings of studies regarding both have overlap:

Low Dose Naltrexone has been studied for many chronic ailments in small studies. Since this is available in generic form there are no big profits to be made by the pharmaceutical industry so do not expect large studies with this medication. (I wish NIH would get on the ball and fund studies of this and other interventions utilizing nutraceuticals such as Rhodiola).

Here is a very hopeful study with regards to Long Covid and Low Dose Naltrexone.

Recovery from symptoms, activities of daily living, energy level, pain, concentration, sleep quality and mood ALL IMPROVED!

If this were a patented drug it would be a BLOCKBUSTER for a pharmaceutical company.

And since Chronic Fatigue Syndrome represents a major portion of Long Covid patients, pathophysiology AND symptoms, here is a study of an adaptogen called Rhodiola (a plant nutraceutical in the category of ADAPTOGEN).

Look at the amazing improvement in major components of CFS/ME which represent the major complaints of many patients with Long Covid.

Post Exertional Malaise, Concentration, Memory and Sleep ALL IMPROVED by more than 50% within eight weeks.

But this is an over the counter supplement, so again, no big profits for big pharma.

Here is a link for a PUBMED search on Rhodiola.

Here is a link for a PUBMED search for Low Dose Naltrexone.

You will note the diversity of clinical applications for Low Dose Naltrexone including autoimmune disease (one possible mechanism of long Covid), neuro-inflammation (another probable mechanism of Long Covid and ME-CFS).

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins.
  12. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Why Do We Not have HEPA filters or Corsi-Rosenthal Boxes in every US Classroom, COVID ward, home and Business?

2 Replies

SARS CoV-2 virus is spread by aerosols. These aerosols contain many viruses carried in a tiny amount of liquid from a person’s mouth and nose as they breath, talk, sing, or yell. Yelling, singing, coughing, sneezing produce more aerosol than breathing. Risk of transmission in a room depends on duration of exposure (time in the room), amount of ventilation, # of individuals carrying the virus present and their activity . A 5 micron aerosol can stay suspended in air for 30 minutes indoors.

HEPA filters (High Efficiency Powered Air-filters) can dramatically reduce the number of aerosols in a room. This includes not only virus carrying aerosols but also small particulate pollutants, both of which impact the health and safety of children and adults in classrooms, meeting rooms and businesses.

HEPA filters range in price from $150 to $800 or more depending on quality, efficiency and how quiet they run. They have been tested in classrooms and hospitals.

In the hospital setting they have dramatically decreased COVID Virus.

To determine how the filters stand up to real-world conditions, Navapurkar and his co-authors installed them in two fully occupied COVID-19 wards — a general ward and an ICU. The team chose high-efficiency particulate air (HEPA) filters, which blow air through a fine mesh that catches extremely small particles. The researchers collected air samples from the wards during a week when the air filters were switched on and two weeks when they were turned off.

In the general ward, the team found SARS-CoV-2 particles in the air when the filter was off but not when it was on. Surprisingly, the team didn’t find many viral particles in the air of the ICU ward, even when the filter there was off. The authors suggest several possible reasons for this, including slower viral replication at later stages of the disease3. As a result, the team says that measures to remove the virus from the air might be more important in general wards than in ICUs.

You can read the article here.

An Engineering professor and Dean at UC Davis, Richard Corsi, tweeted the design of an inexpensive homemade air filter providing the equivalent aerosol clearing capacity as an expensive manufactured HEPA filter. A colleague in Texas built one with simple components from a hardware store. The result was called the Corsi-Rosenthal box.

Made with four MERV 13 Airfilters, a box fan , duct tape and cardboard.

Dr. Corsi is an expert in the engineering of HVAC systems. He has researched methods to improve indoor air quality and published many scientific studies involving the interaction between pollutants and indoor materials. He estimates that the cost of a home-made Corsi-Rosenthal box is $4.50 per year per student to build and run based on average class size in the US. These are easily made with simple components and instructions available on-line. In fact if you search YouTube you will find many short videos on how to build these in 20 minutes. Their construction and use could easily be a classroom activity.

Professor Corsi was interviewed on the People’s Pharmacy radio show.

Here is a picture of the Corsi-Rosenthal box from Wikipedia:

One box can help to improve the air quality in an average size classroom, offering the equivalent of 7 to 8 air changes an hour.

These boxes would not only benefit health by decreasing circulating virus containing aerosols but also filtering out indoor pollutants that come from latex paint, carpet fibers, cleaning chemicals, air fresheners, fire retardants on furniture and clothing, which all release volatile organic compounds (VOCs) that cause lung damage, increase risk of asthma and autoimmune disease. So why have these not been widely used in our schools, homes, and businesses?

Why has the CDC not recommended this simple and inexpensive highly effective risk reduction approach? If widely implemented soon after Drs. Corsi and Rosenthal invented and advocated it’s use, it would have prevented many infections and allayed some of the fear and anxiety of teachers, students and parents. As the flu season approaches, and with the added risk of a triple threat presented by RSV, Influenza, and Covid, all transmitted by aerosol, now would be a great time to build some for your home, business, office or your chidren’s school classrooms.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins.
  12. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Excess deaths during Pandemic: Covid infection vs Vaccine

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Vax skeptics continue to claim that deaths and side-effects of the vaccine have been under-reported and the risk-benefit ratio of vaccines has been under-estimated. Many claim that the vaccine has produced more harm than good.

I do not agree.

Recently a UK cardiologist has been interviewed in the social media, claiming to have published in a “peer-reviewed journal” the dangers of vaccinations. But the media-hyped reports of his “peer-reviewed” paper have failed to report scientific debunking of his claims.

You can enjoy the debunk here.

this is worth the time.

Dr. Seheult, a quadruple boarded physician, produces on-line medical education and reviews for the lay public on many medical issues including COVID-19, vaccinations, and misinformation. He discusses excess mortality (deaths higher than expected based on historical seasonal variations) in a superb video here.

Very much worth a watch.

Summary:

  1. During the pandemic, excess death spikes correlated with surges in Covid-19 infections not with vaccination.
  2. Potential causes include Covid infections, decreased cancer screening and treatment, hesitancy to seek necessary medical care (emergency rooms and office visits), overburdened hospital and out-patient care because of Covid infections (limited ICU beds, hospital beds, primary care visits, etc.). With limited resources including staff, ICU beds, hospital beds, and primary care, when these resources are filled by Covid surges, patients with other needs do not get the usual care they deserve. Likewise, many patients avoid seeking medical care out of fear.
  3. Other contributing factors likely include social isolation, depression, lack of exercise, lack of sunshine, disturbed sleep, pandemic anxiety, pandemic related stress all of which increase risk of acute and long-Covid as well as other medical problems.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins.
  12. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (diabetes, pre-diabetes, insulin resistance, hypertension, heart disease, COPD, obesity, immune suppression, asthma) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially healthy males, without risk factors, may equal benefits. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefit with your physician.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Long Haulers, Brain Fog and Post Exertional Malaise

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An excellent article recently published in the Atlantic was so well written that I have cut and pasted important snippets to help create this post. The review confirms many findings uncovered in my reading of several scientific publications.

You can read the full article here:

The crushing fog of long COVID

20 to 30 percent of patients report brain fog three months after their initial infection, as do 65 to 85 percent of the long-haulers who stay sick for much longer.

Of long COVID’s many possible symptoms, brain fog “is by far one of the most disabling and destructive,”

It is more profound than the clouded thinking that accompanies hangovers, stress, or fatigue.

It is not a mood disorder.

It is almost always a disorder of “executive function”—the set of mental abilities that includes:

  1. focusing attention,
  2. holding information in mind, and
  3. blocking out distractions.

Patients state they often lose focus mid-sentence.

Difficulty with simple tasks impairs activities of daily living.

“I couldn’t unload a dishwasher, because identifying an object, remembering where it should go, and putting it there was too complicated.”

The memories are there, but with impaired executive function, the brain neither chooses the important things to store nor retrieves that information efficiently.

Most people with brain fog are not so severely affected, and gradually improve with time. But even when people recover enough to work, they can struggle with minds that are less nimble than before.

“I’ve had surgeons who can’t go back to surgery, because they need their executive function,” Monica Verduzco-Gutierrez, a rehabilitation specialist at UT Health San Antonio.

That specific constellation of problems also befalls many people living with HIV, epileptics after seizures, cancer patients experiencing so-called chemo brain, and people with several complex chronic illnesses such as fibromyalgia.

It’s part of the diagnostic criteria for myalgic encephalomyelitis, also known as chronic fatigue syndrome, or ME/CFS

People with brain fog also excel at hiding it: to protect their jobs when still able to work, or to protect their reputation, or out of embarrassment.

“I know my value in many people’s eyes will be diminished by knowing that I have these cognitive challenges.”

Individuals with previously above average cognitive ability often test “normal” but suffer significant loss compared to their prior ability.

A team of British researchers analyzed data from the UK Biobank study. The findings revealed structural changes in the brain with loss of tissue on MRI scans that correlates with symptoms.

They found that even mild infections can slightly shrink the brain and reduce the thickness of its neuron-rich gray matter. At their worst, these changes were comparable to a decade of aging.

They were especially pronounced in areas such as the parahippocampal gyrus, which is important for encoding and retrieving memories, and the orbitofrontal cortex, which is important for executive function.

In most cases the virus probably harms the brain without directly infecting it.

Inflammatory chemicals can travel from the lungs to the brain, where they disrupt cells called microglia (immune cells in the brain).

In their presence, the hippocampus—a region crucial for memory—produces fewer fresh neurons, while many existing neurons lose their insulating coats (demyelination), so electric signals now course along these cells more slowly.

These are the same changes seen in cancer patients with “chemo fog”.

Neuro-inflammation is “probably the most common way” that COVID results in brain fog, but that there are likely many such routes, such as reactivation of dormant viruses such as Epstein-Barr virus, which has been linked to conditions including ME/CFS and multiple sclerosis.

By damaging blood vessels and filling them with small clots, COVID also throttles the brain’s blood supply, depriving this most energetically demanding of organs of oxygen and fuel.

These problems can be exacerbated or mitigated by factors such as sleep and rest, which explains why many people with brain fog have good days and bad days.

Although other respiratory viruses can wreak inflammatory havoc on the brain, SARS-CoV-2 does so more potently than influenza.

For adults following SARS CoV-2 infection:

risks of cognitive deficit (known as brain fog), dementia, psychotic disorders, and epilepsy or seizures were still increased at the end of the 2-year follow-up period.

For children following SARS CoV-2 infection:

in the 6 months after SARS-CoV-2 infection, children were not at an increased risk of mood (HR 1·02 [95% CI 0·94–1·10) or anxiety (1·00 [0·94–1·06]) disorders, but did have an increased risk of cognitive deficit, insomnia, intracranial haemorrhage, ischaemic stroke, nerve, nerve root, and plexus disorders, psychotic disorders, and epilepsy or seizures (HRs ranging from 1·20 [1·09–1·33] to 2·16 [1·46–3·19])….  Unlike adults, cognitive deficit in children had a finite risk horizon (75 days) and a finite time to equal incidence (491 days).

The fact that neurological and psychiatric outcomes were similar during the delta and omicron waves indicates that the burden on the health-care system might continue even with variants that are less severe in other respects.

There are no proven drug treatments for long-haulers.

But there is hope.

Cancer researchers have developed drugs that can calm inflamed microglia in mice and restore their cognitive abilities;

“Metformin can promote the regeneration of neural precursor cell populations and improve cognitive function in a preclinical model of cranial radiation and a pilot clinical study of children after cranial radiation and chemotherapy.”

Treating cancer therapy–related cognitive impairment | Nature Medicine

With regard to long-haulers, better sleep, healthy eating, and other generic lifestyle changes can make the condition more tolerable. Breathing and relaxation techniques can help people through bad flare-ups; speech therapy can help those with problems finding words.

“Some people spontaneously recover back to baseline,”

The largest group of long-haulers—those whose brain fog has improved but not vanished, can “maintain a relatively normal life, but only after making serious accommodations,”

Patients struggle to make peace with how much they’ve changed and the stigma associated with it, regardless of where they end up.

Post-exertional malaise—severe crashes in which all symptoms worsen after even minor physical or mental exertion is commonly reported.

Many long-haulers try to push themselves back to work and instead “push themselves into a crash,”

Post-exertional malaise is so common among long-haulers that “exercise as a treatment is inappropriate for people with long COVID,”

Even brain-training games—which have questionable value but are often mentioned as potential treatments for brain fog—must be very carefully rationed because mental exertion is physical exertion.

People with ME/CFS learned this lesson the hard way, and fought hard to get exercise therapy, once commonly prescribed for the condition, to be removed from official guidance in the U.S. and U.K.

In summary:

  1. Brain fog can occur even after mild or asymptomatic Covid-19.
  2. Although many patients improve over time, many are left with disability that can range from mild to incapacitating.
  3. Although these symptoms can occur following any viral infection, SARS CoV-2 seems to produce this with greater frequency compared to other viruses.
  4. Chronic brain inflammation is the likely cause in many individuals.
  5. Reactivation of Epstein Barr and/or other dormant viruses is suggested by various immune markers.
  6. The immune signature also suggests an immune response that mimics persistent infection in the absence of live SARS CoV-2 virus.
  7. Post exertional malaise following physical or mental exercise is a common and debilitating symptom without proven treatments. However there are guidelines that may help mitigate this devastating condition.
  8. Brain fog and post-exertional malaise are hallmarks of chronic fatigue syndrome/Myalgic encephalomyelitis which can occur following viral infections and major stress events such as physical and psychological trauma.
  9. Although not discussed in this post, chronically suppressed cortisol levels have been identified in this population. This in combination with physical changes noted on brain MRI demonstrate that there are physical correlates of brain fog.

In the meantime, preventive measures represent the low hanging fruit for health in general and with respect to the pandemic.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins.
  12. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors means clear benefit from a booster.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Global Food Justice Alliance

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My friend Diana Rogers, started the Global Food Justice Alliance. This organization brings unbiased science to the discussion of meat consumption as it relates to health AND the environment. As discussed previously (see regenerative agriculture posts), properly raised ruminants (beef, pork, lamb, etc.) are ecologically sound, help create soil and fight climate change, and provide important nutrient dense food for people of all ages. The anti-meat narrative in popular media presents a false and dangerous position that threatens our environment, soil conversation/creation, and health.

For more information go here:

Regenerative sustainable agriculture (depicted on the right) , minimizes use of fossil fuel and fossil oil based fertilizer. Instead it utilizes ruminant animal waste for fertilizer, creates living soil and biologic diversity. Mono-agriculture depicted on the left, destroys soil, depletes nutrients in food, contaminates our food with pesticides, creates downstream runoff environmental degradation, and contributes to climate change. The documentary “Kiss the Ground” documents these important concerns.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins.
  12. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors means clear benefit from a booster.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

AHS 2022 Lecture, Acute and Long Covid, Nutritional and Lifestyle Immunology

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I recently gave a talk at the AHS 2022 meeting held at UCLA. You can view the video here:

This first slide gives a good overview.

The presentation covers a quick review of my presentations given last year at the PAH 2021 annual meeting (virtual) with additional information on long Covid.

Multiple nutrients acting synergistically support a balanced response to viral infections, including SARS CoV-2. Here is a picture.

The take home message is that no single nutritional intervention is likely to have significant impact with an acute infection unless all but one nutritional component is optimal. Nevertheless, there is compelling evidence that Vitamin D deficiency is rampant in the developed world and if one nutritional intervention is likely to be of benefit, Vitamin D supplementation, particularly in high risk populations, presents the most likely candidate. As usual, preventive supplementation would be preferable to rescue high dose intervention.

In a study of frail elderly hospitalized patients, regular vitamin D supplementation was associated with decreased mortality as demonstrated here. Compared to no supplementation, regular supplementation was associated with a 93% reduction in risk of death.

A study from Spain with very high dose Vitamin D in the form of Calcifediol showed significant benefit in hospitalized patients, suggesting that Vitamin D deficiency was prevalent in that population and that such a treatment intervention should be widely considered.

Calcifediol Treatment and COVID-19-Related Outcomes

Click to access dgab405.pdf

The following graphic from another nutrition review article, with red additions added by myself, demonstrates the complex interaction between nutrition and the two main components of our immune system, innate immunity (immediate response) and adaptive immunity (based on immune memory). Again red highlights added by yours truely.

And here is a slide from my lecture with quotes from that article.

Yet most Americans are deficient in many of these essential nutrients as depicted here. The percentages represent the % of Americans that fall below the estimated amount required to prevent deficiency in HALF of adults (a very low standard).

The EAR is a very low bar to meet, yet many Americans fall below even that low standard.

The SARS CoV2 virus interferes with a crucial component of the the initial (innate) immune response, the production of interferon 1 and the signaling of interferon one to immune cell mediators as depicted in this graphic.

SARS CoV2 on the left is compared to Virus X on the right. On the left interferon 1 (IFN) production and signaling is blocked by the virus, interfering with an effective and controlled immune response, on the right IFN is not blocked. A cascade of events results in TOO LITTLE, TOO LATE, AND THEN TOO MUCH of an immune response, producing a cytokine storm.

Obesity, insulin and leptin resistance, also interfere with the production and signaling of interferon. The result is that people with insulin and leptin resistance (pre-diabetes, Type 2 Diabetes as well as sarcopenia) experience a double hit. First the virus itself disrupts the immune response and superimposed upon the viral effect is the effect of insulin and leptin resistance on the immune response.

SOCS: suppressor of cytokine signaling. Several recent viral studies have shown that viral genes can hijack SOCS1 to inhibit host antiviral pathways, as a strategy to evade host immunity
On the left Interferon production and signaling are normal and a successful immune response is mounted. On the right the presence of insulin and leptin resistance, associated with obesity results in an initial inadequate response and a late excessive response. TOO LITTLE, TOO LATE, THEN TOO MUCH.

Factors that can quickly impact insulin and leptin resistance include all the components of an ancestral lifestyle depicted in my website graphic. A paleolithic or ancestral diet that eliminates sugar added foods and beverages, replacing those empty calories with nutrient dense foods, exercise, adequate restorative sleep, stress reduction, avoidance of environmental toxins, social connection. All of these affect health in general, mitigate insulin and leptin resistance, and support a balanced immune response to viral infection. The circle of health depicted below is surrounded by the many deleterious aspects of modern living. Thus, a mismatch between our evolutionary biology and present day life.

Here is a slide from my lecture that lists many lifestyle factors that can impact infection with any virus, including SARS CoV-2

My lecture also included discussion of Long COVID, theories of etiology and pathophysiology which will be discussed in my next post.

For the full lecture which is about 34 minutes long, please follow the link above.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob