Category Archives: vitamin D

Omega-3 fatty acids, Pain and Arthritis

Leave a reply

Before modern pharmacy an early treatment for Rheumatoid Arthritis (RA) was cod liver oil, rich in omega-3 fats and vitamin D. A 2013 study demonstrated that consumption of cod liver oil resulted in a reduction of daily diclofenac in Rheumatoid Arthritis. As early as 1959 cod liver oil was recommended for arthritis in the medical literature. A 2017 review of marine omega-3 fats for arthritis pain found moderate quality evidence in rheumatoid arthritis patients. A 2024 review of prevention and treatment for RA suggested that a diet rich in fiber, vitamins, omega 3 and low glycemic index foods contributes to protection from RA. A comprehensive review of omega-3 fatty acids for RA included analysis of several studies and concluded that omega-3 was a valuable therapeutic option to improve pain symptoms, tender joint count, duration of morning stiffness and the frequency of NSAID consumption. A 2019 review of cumulative data on omega-3 fats to combat autoimmune diseases concluded:

“The promising findings coming from the cumulative research work over the last decade solidified the role of ω-3 PUFAs as a potential candidate to prevent or even treat such autoimmune diseases as type 1 diabetes, RA, SLE, MS”

A 2024 review of marine omega-3 PUFA (polyunsaturated fatty acids) for RA reported:

“Altogether the data reported in this review show that anti-inflammatory interventions, i.e., high fish consumption or supplements containing n-3 PUFAs, should be the standard of care, along with pharmacotherapy, in treating patients with RA.”

And here is a graphic from that article showing the effect of SPMs (specialized pro-resolving mediators, derived from omega-3s):

What about osteoarthritis?

A multicenter randomized double blind placebo controlled trial of krill oil containing 0.60 g EPA/d, 0.28 g DHA/d, 0.45 g astaxanthin/d demonstrated improvements in pain, stiffness and physical function.

Some omega-3 supplement studies have demonstrated no significant pain relief in osteoarthritis. Those studies did not reduce the consumption of pro-inflammatory n-6 fatty acids which compete with omega-3 fats for the enzymes which can lead to pro or anti-inflammatory mediators. They also did not measure the omega 6/omega 3 ratio in blood or tissues. Nor did they measure the omega-3 index (% of omega-3 achieved in red blood cell membranes, the gold standard for evaluating tissue levels achieved) This 2018 analysis stated:

“High Omega-3 (n-3) polyunsaturated fatty acids (PUFAs) are associated with lower levels of inflammatory mediators, anti-nociception, and adaptive cognitive/emotional functioning. High Omega-6 (n-6) PUFAs are associated with inflammation, nociception, and psychological distress. While findings related to n-3 supplementation in knee OA are mixed, consideration of the n-6:n-3 ratio and additional outcome measures may provide improved understanding of the potential relevance of these fatty acids in OA”

The authors went on to access blood n-6/n-3 ratios in patients with OA and found the following:

“The high ratio group reported greater pain and functional limitations, (all p’s<0.04), mechanical temporal summation (hand and knee, p<0.05), and perceived stress (p=0.008) but not depressive symptoms.”

“In adults with knee pain, a high n-6:n-3 ratio is associated with greater clinical pain/functional limitations, experimental pain sensitivity, and psychosocial distress compared to a low ratio group.”

The anti-inflammatory diet that I follow and recommend eliminates the major sources of excess omega-6 in the diet, specifically the “vegetable oils” which are actually seed, grain, and legume oils predominated by soy oil, corn oil, peanut and cottonseed oil present in cooking “vegetable oils” and processed foods. A table that displays the ratio of omega 3 to omega 6 in various oils can be found here. Note that this table does not reveal the amounts of MUFA (mono unsaturated fatty acids) which are arguably “heart healthy”. Nor does it address the important issue of protective polyphenols and anti-oxidants (such as in Extra Virgin Olive oil aka EVOO). So do not make choices of oil based only on the omega-3/6 ratio.

Another consideration in choosing oils for cooking (as opposed to salad dressing) is the smoke point. Under high heat, oils are subject to oxidation which creates a proinflammatory effect when consumed. Refined Avocado oil has the highest smoke point (520 degrees F). But we digress. Back to pain and arthritis.

An article just published in Nutrients reviewed Omega-3 Supplementation and Its Effects on Osteoarthritis.

“omega-3 polyunsaturated fatty acids (PUFA) have demonstrated an influential role in the progression of OA, resulting in the reduction of cartilage destruction, inhibition of pro-inflammatory cytokine cascades, and production of oxylipins that promote anti-inflammatory pathways.” 

“Research has demonstrated a positive effect on the modulation of OA symptoms through diet and exercise to promote an anti-inflammatory environment. More specifically, omega-3 PUFAs have demonstrated a reduction in inflammatory biomarkers and cartilage degradation, counteracting the natural disease state of OA. In addition to their chondroprotective role, omega-3 supplementation has been shown to have indirect positive effects on muscle tissue recovery following exercise, which is necessary to prevent the progression of OA and maintain an independent, healthy lifestyle. The effects of omega-3 supplementation on the disease state of OA and its symptoms remain inconclusive. Further clinical trials utilizing human participants are warranted to provide a conclusive recommendation on standardized supplementation of omega-3 for the modulation of osteoarthritis.”

Given the cardioprotective effects, discussed in my last post (including an 80% reduction in sudden death at the highest quintile of omega-3 index) and other benefits (reduction in all cause mortality with high tissue levels), there are many reasons to include large amounts of low mercury fatty fish (wild Alaskan salmon, sardines, herring, trout) in the diet and to consider supplementation when your omega 3 index is < 8%. Likewise, in the presence of arthritis and pain, getting tissue levels of omega 3 up and reducing excessive pro-inflammatory omega 6 will likely provide significant benefit.

Here is a graphic with the omega 3 content of some foods.

And another:

As mentioned in my previous post about omega-3 and cardiovascular health, 1800 mg of omega-3 FA daily is adequate in most people to achieve and omega-3 index of 8%, the level at which cardiovascular protection is greatest.

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

4th International Evolutionary Health Conference

Leave a reply

Sorry for the confusion. The website for the International Evolutionary Health Conference changed when the venue changed from Boston to Virtual. Here is the correct website link which gives a list of speakers/topics and sign up information. 

https://2023.evolutionaryhealthconference.com/

The previously published link will lead you to a site that says “canceled”. The conference is not cancelled, the venue has changed to virtual. 

Dr. Bob

/

Fourth International Evolutionary Health Conference

Leave a reply

I’ve been asked to talk at the fourth International Evolutionary Health Conference on the topic of Cardiovascular Risk Assessment. This year the conference is virtual. Presenters include clinicians and researchers discussing many topics related to health. The underlying principle of this approach attributes modern degenerative and chronic diseases to mismatch between our evolutionary biology and present day life. You can sign up for this virtual event here.

https://2023.evolutionaryhealthconference.com/

Agenda

9:45 AM – 10:00 AM

Opening remarks

Prof. Lynda Frassetto

10:00 AM – 10:30 AM

Maladaptive cognitive/emotional processing as the cause of the stress response

Prof. Igor Mitrovic

Physiologic reserve is spare capacity activated when demand exceeds baseline, causing stress. If demand surpasses reserve, it damages the system and leads to death. The brain predicts the future to a…
View More

10:30 AM – 11:00 AM

How breathing patterns affect health

Dr. Michael Mew

11:00 AM – 11:15 AM

Round table with Q & A (Moderator: Darryl Edwards)

Dr. Michael Mew

Prof. Igor Mitrovic

11:15 AM – 11:45 AM

Break and Poster session

If you would like to submit a poster, please contact us at evolution.conference@nutriscience.pt

11:45 AM – 12:15 PM

Decoding The Truth: Cancer, Carbs and Cure

Darryl Edwards, MSc

1. We will delve into the extensive evidence showcasing how higher levels of physical activity can reduce the risk of various cancers. 2. While awareness of the importance of exercise exists, we will…
View More

12:15 PM – 12:45 PM

Influential factors on sun-induced vitamin D synthesis

Pedro Bastos, PhD candidate

Ultraviolet B radiation is absorbed in the epidermis by 7-dehydrocholesterol, giving rise to previtamin D3 and subsequently to vitamin D3. In the liver, vitamin D is converted to one of the various c…
View More

12:45 PM – 1:00 PM

Round table with Q & A (Moderator: Prof. Lynda Frassetto)

Darryl Edwards, MSc

Pedro Bastos, PhD candidate

1:00 PM – 2:15 PM

Lunch Break

2:15 PM – 2:45 PM

How nutrition can impact microbiome composition/permeability/immune response

Prof. Alessio Fasano

Improved hygiene and reduced microorganism exposure are linked to the ‘epidemic’ of chronic inflammatory diseases (CID) in developed nations. This hygiene hypothesis suggests that lifestyle and envir…
View More

2:45 PM – 3:15 PM

Comprehensive cardiovascular risk assessment

Dr. Robert Hansen

Assessing insulin resistance is central to predicting CV risk. LDL-C and standard lipid profile is extremely limited in predictive value. A systems engineering understanding of atherosclerosis and ev…
View More

3:15 PM – 3:30 PM

Round table with Q & A (Moderator: Pedro Bastos)

Prof. Alessio Fasano

Dr. Robert Hansen

3:30 PM – 3:45 PM

Short Break

3:45 PM – 4:15 PM

Environmental influences on cellular senescence and aging

Prof. Peter Stenvinkel

Planetary health recognizes that human well-being depends on the health of ecosystems. Neglecting this concept has led to an anthropocentric world, causing increased greenhouse gas emissions, heat st…
View More

4:15 PM – 4:45 PM

Fueling a Bright Future: The Role of Diet in Preventing Childhood Obesity

Dr. Polina Sayess

Childhood obesity is a global health issue. In my presentation, I’ll explore its origins, classifications, and mitigation strategies. I’ll discuss the definitions and distinctions between “overweight…
View More

4:45 PM – 5:00 PM

Round table with Q & A (Moderator: Prof. Lynda Frassetto)

Prof. Peter Stenvinkel

Dr. Polina Sayess

5:00 PM – 5:30 PM

Final discussion with all speakers and moderators

Establishing future research and intervention directions.

5:30 PM – 5:45 PM

Closing remarks

Prof. Lynda Frassetto

Please join us if you can.

Dr. Bob

The argument for cattle grazing and meat consumption: COP27

Leave a reply

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

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

Leave a reply

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

COVID UPDATE FROM Institute of Functional Medicine

Leave a reply

I just viewed an excellent video presentation from the Institute of Functional Medicine providing very useful data on COVID, particularly focusing on the Omicron variants. You can watch it here:

COVID-19 Functional Medicine Resources – The Institute for …

https://info.ifm.org/covid-19

I will summarize the information. But first a few disclaimers.

  1. I have not vetted all of these notes but none disagree with any reports or studies I have read
  2. I have read many but not all of the studies that support these statements
  3. I viewed the video with frequent pauses and replays to facilitate accurate note taking. If you view the video and find any errors please make a comment.
  4. I had a mild case of breakthrough COVID last week and seem to have some brain-fog, feeling like the morning after working most of the night on-call in the operating room.
  5. Many general observations on varied topics related to COVID-19

Omicron Timeline:

11/11/21 Omicron first appears,

1/15/22 Omicron is 99.5% of US cases

1/26/22 B.2 variant appears in US and Europe

2/5/22 B.2 variant 3.6% of US cases

Omicron presents with about 50 mutations, 15 on the RBD (receptor binding domain) with increased affinity for the ACE 2 receptor

Omicron has a cluster of mutations at the S1S2 Furin Cleavage Site. Furin is an enzyme that cleaves the virus to allow for entry into human cells, present in large amounts in the brain, lung and GI tract (thus omicron affecting these organs perhaps more and possibly increasing the risk in people with comorbidities “associated with Furin”.)

Some Omicron mutations are associated with a degree of immune escape, evading anti-bodies and T cells.

B2 may not be picked up by some tests (not discussed in detail)

Compared to B1, B2 is 2.5 times more transmissible in non-VAX folks.

But Vaccine effectiveness against B2 appears to be at least as good or possibly better than effectiveness against B1. (Strange but stated)

Omicron has on average a 3 day latency between infection and symptoms. It appears to replicate “70X more quickly” compared to delta with 3.5 times greater household transmission. Fortunately lung involvement is 10 times lower compared to the original “Wuhan virus”.

Prior infection with delta DOES NOT SEEM TO PROTECT AGAINST OMICRON.

Hospitalization rate with omicron 38/1000 infections vs 101/1000 infections with delta.

In hospital mortality 29% with delta vs 3% with Omicron BUT because of a dramatic increase in transmission with Omicron, daily death rate in US has been 2200 to 2900 per day during the surge, more than delta. (Greater number of infections outweighs the lower mortality rate)

 A preprint study published last month looked at data from about 52,000 people infected with the omicron variant, and about 17,000 infected with delta, in southern California. Compared with patients who had the delta variant, omicron patients had a 53% reduced risk of hospitalization, a 74% reduced risk of ICU admission and a 91% reduced risk of death. The study has not yet been peer-reviewed.

Duration of infection averages 10 days. Estimates for being contagious after onset of symptoms:

5 days 1/3, 7 days 16%, 10 days 5%, therefor some practitioners are recommending isolation for 14 days after onset of symptoms.

PCR can remain positive for months after infection because of non-infectious remnants of viral RNA.

Negative antigen test after isolation is reassuring but does not guarantee patient is not contagious. The home antigen tests were not designed or studied for predicting degree of contagion, only for diagnosis.

LONG COVID can be as high as 30% of all cases, as high as 10% after mild cases.

Vaccination reduces risk of LONG COVID by about 50%.

A study published in GUT demonstrates altered GI microbiome 6 months after infection. The gut microbiome is extremely important for immune function.

One year following COVID infection (previous variants) there is a 60-70% increased risk of heart attack, stroke and congestive heart failure.

In the UK 25% of worker absenteeism is due to LONG COVID.

Infection rates: UNVAX 1000/100,000, VAX 600/100,000, VAX+BOOSTER 300/100,000

A Swiss study showed 98% reduction in death with VAX plus booster.

2/15/22 published study from IOWA showed that 90 minutes of exercise on the day of vaccination increased antibody levels measured 4 weeks after vaccination. Similar data are available for influenza vaccination. I reviewed data on various non COVID vaccine effectiveness relative to sleep and exercise in 2 talks given last year. This result is not surprising.

Individuals with infection from prior variants, but not vaccinated, show no effective neutralizing antibody activity against omicron. (Very worrisome, I will try to vet this one)

Omicron has 4.5 times higher re-infection rate compared to delta.

Omicron infection appears to decrease risk of infection with delta, but prior infection with delta (without vaccination) does not appear to protect against omicron.

Prior infection (before omicron) PLUS vaccination provides 76% protection against omicron infection which is about the same protection of VAX + booster, and this appears to include protection against B2 variant.

T cell immunity after infection (pre omicron) and after vaccination appears to persist and T cell activity increases with time after infection and after vaccination.

Novavax has applied for EUA with the FDA. This is a vaccine made with S-protein particles plus adjuvant (no mRNA).

“The Novavax COVID-19 vaccine, codenamed NVX-CoV2373, is a subunit COVID-19 vaccine candidate developed by Novavax and the Coalition for Epidemic Preparedness Innovations (CEPI), brand name Covovax.”

“Results from a Phase 3 clinical trial enrolling 29,960 adult volunteers in the United States and Mexico show that the investigational vaccine known as NVX-CoV2373 demonstrated 90.4% efficacy in preventing symptomatic COVID-19 disease. The candidate showed 100% protection against moderate and severe disease. In people at high risk of developing complications from COVID-19 (people 65 years or older and people under age 65 with certain comorbidities or with likely regular exposure to COVID-19), the vaccine showed 91.0% efficacy in preventing symptomatic COVID-19 disease.”

Read more on en.wikipedia.org

The US Army is in phase I clinical trial with a multi-valent “ferritin nanoparticle multi-faced” vaccine. This “soccer ball shaped” vaccine has 24 “faces” with multiple variant antigens. Each “face” carries a different antigen.

US Army developing vaccine to fight ‘array’ of COVID variants

“The Spike Ferritin Nanoparticle platform is designed to protect against an array of SARS-CoV-2 variants and SARS-origin variants but was not tested on the Omicron variant,” Walter Reed officials said.

J&J vaccine issues:

The J&J vaccine is associated with a risk of thrombosis-thrombocytopenia (blood clots and decreased platelets). Risk: 1:100,000 doses in women age 30-50. CDC recommends against J&J vaccine unless there is a contra-indication to mRNA vaccine. 15% of these cases are fatal.

A full discussion of therapeutics (drugs) against COVID can be read at IFM.org/COVID

PAXLOVID is an oral combination of two anti-viral medications reserved for adults (age >= 18) with increased risk, given within day 3-5 of symptom onset. It decreases risk of hospitalization and death by about 70% in low-risk and 89% in high risk groups. There are many contra-indications to use including specific medications and supplements (such as Saint John’s Wort). Availability is a problem.

A recent study published in NEJM used IV Remdesivir (daily for 3 days) for early out- patient treatment in high risk patients, reduced risk of hospitalization/death by 87%. This would represent an off-label use of the drug based on a well controlled study.

Home antigen tests on average become positive 3 days after first positive PCR (nasal swab), 2 days after a positive saliva PCR.

The BiaxNOW home antigen test is 73% sensitive (27% false negative rate)

Pregnancy-COVID and vaccination:

A study of 40,000 pregnant women found no increase in pre-term birth, small for gestational age, or any other complication following vaccination during pregnancy.

But COVID infection in unvaccinated women during pregnancy is associated with increased risk for pre-term birth, still born, low birth weight, cesarean section, decreased fetal growth, maternal intubation and death.

Maternal Vaccination produces anti-Covid antibodies found in fetal cord blood at birth.

Intra-uterine demise with COVID is associated with massive placental insufficiency.

There is no data to support decreased female or male fertility following vaccination.

A study of menstrual regularity following vaccination showed < 1 day change in cycle length post vaccination, not clinically significant. Post vaccination regularity equivalent to expected variation in menstrual cycles.

Two months following COVID infection there is a decrease in male but not female fertility rate.

Multiple studies have demonstrated association between low Vitamin D status and risk for severe-critical disease and death. Association does not equal causation but there is biologic plausibility (Vitamin D is a major immune regulator) and consistently increased risk associated with low levels. A recent study demonstrated 14 times greater risk for severe-critical disease in hospitalized patients with levels <20 compared to patients with levels >40. I will update my previous discussion of Vitamin D and COVID in a future post. Spoiler alert: An intervention study with high dose Vitamin D done in Spain demonstrated improved clinical outcome.

Risk factors for poor outcome in descending order:

  1. Age > 65
  2. immuno-compromised state
  3. lung disease
  4. liver disease
  5. kidney disease
  6. neurologic disorders
  7. diabetes
  8. cardiac disease

Patients with severe disease had >= 1 risk factor

78% of patients who died had >= 4 risk factors.

“Nearly two years into the pandemic, unvaccinated Americans are still making up the majority of COVID deaths.”

“Data from the Centers for Disease Control and Prevention shows that during the first week of December — when the omicron variant began taking hold — unvaccinated people were dying at a rate of 9 per 100,000.”

“By comparison, fully vaccinated people were dying at a rate of 0.4 per 100,000, meaning unvaccinated people were 20 times more likely to die of the virus”

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

Nutrition and Lifestyle vs Pandemic

Leave a reply

Earlier this year I gave 2 presentations on this topic at the (virtual) annual meeting of Physicians and Ancestral Health, a physician organization dedicated to incorporating evolutionary biology and lifestyle recommendations into the practice of medicine. Here is the first slide:

And here are some very important references:

Please note that this lecture was given before the delta variant arrived so the data applies to the pre-delta period.

MI= Myocardial Infarction (heart attack with loss of muscle), PE=Pulmonary Embolus, DVT= Blood Clots in legs, SIRS= Systemic Inflammatory Response Syndrome

I will skip several of the slides and get to the nutritional immunology and other lifestyle factors.

This slide shows many lifestyle factors that interact with the immune system. The “12% metabolic health” refers to a study demonstrating that only 12% of American adults are metabolically healthy, which will be explained later. Dysbiosis refers to an imbalance in gut bacteria favoring inflammation and immune compromise. The rest should be self explanatory but discussed in detail later in this series.

Here is the very busy slide that summarizes nutritional immunology:

w3/w6 refers to the omega 3 to omega 6 ratio in the diet, ROS= Reactive oxygen species (oxidative stress), CH: carbohydrates; GALT: gut-associated lymphoid
tissue; GPRs: G-protein-coupled receptors; FA: fatty acids; GI/GL: glycemic index/load; RAR/RXR:
retinoic acid receptor/retinoid X receptor; SCFA: short-chain fatty acids; TF: transcription factors; VDR:
vitamin D receptor.

Key points in this slide:

  1. Omega 3 fats from fatty fish fight inflammation, excess omega 6 fats from refined “vegetable oils” (corn, soy, cotton seed, sunflower seed, safflower, etc.) contribute to inflammation and blood clots, contributing to cytokine storm and bradykinin storm.
  2. Vitamin D interferes with the virus at multiple points.
  3. Adequate iron (Fe) from meat and seafood is essential for immune function (Iron from plant sources is much less bioavailable compared to meat and seafood.)
  4. Adequate complete protein (not available from vegan diets) is essential for immune function.
  5. Zinc and selenium (both found in seafood and meat) are essential for multiple protective pathways in the immune system (enhancing response to infection and mitigating excessive inflammatory response as cofactors for antioxidant enzymes)
  6. Sugar and high glycemic foods cause inflammation, high blood sugars suppress the immune system
  7. Dietary fiber supports a healthy gut microbiome which in turn suppresses inflammation and provides the gut lining with SFAs (gut epithelium requires SFAs for energy and function, gut barrier function needs SFAs)
  8. Phenolic compounds in colorful vegetables and berries modulate multiple essential immune pathways that can inhibit viral replication.
  9. Carotenoids, phenolics support several vital immune pathways.
  10. Omega 3 fats are the building blocks of chemicals that help resolve inflammation and mitigate against cytokine storm and bradykinin storm.
  11. Multiple vitamins and phenolics support our internal anti-oxidant system.
  12. To get a balanced protein intake we should eat “nose to tail”. Include connective tissue (home made bone broth is a great source) and organ meats (from grass fed/finished ruminants) in addition to muscle meat.

Here is another busy slide that presents more detail, note the reference at the bottom of the slide to read more.

Sorry for the small print but you can see the blow up on line by going here.

http://A Review of Micronutrients and the Immune System-Working …

So does the “Standard American Diet” meet these nutritional needs to support a healthy immune system?

The % above represent the % of American adults with intakes BELOW the EAR (Estimated Average Requirement) for various vitamins and minerals. But note the definition of EAR:

“nutrient intake value that is estimated to meet the requirement of half the healthy individuals to avoid symptoms of a clinical or subclinical deficiency” (NOT OPTIMAL LEVELS for immune function)


Note also that this study did not consider omega-3s, phytonutrients, flavonoids, polyphenols, fiber, etc., all of which are essential to a robust immune response to any virus including SARS CoV-2.

With regards to omega 3 vs omega 6 fats:

Omega 3 fats (EPA and DHA) found in seafood fights inflammation, blood clots. DHA and EPA are the building blocks of SPMs which help RESOLVE INFLAMMATION (MITIGATE CYTOKINE STORM)

We will return to this topic in my next post. We are just scratching the surface of a complex system.

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. (read this Open Letter)
  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. If you are over age 12 and eligible for vaccination, consider protecting yourself and your neighbor with vaccination.

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

COVID-19 UPDATE: Masks, social distancing much more important than cleaning surfaces.

2 Replies

Today’s update from the Johns Hopkins Center for Health Security:

An editorial published in Nature discusses the need to shift focus away from surface decontamination as a mechanism to reduce SARS-CoV-2 transmission risk. Multiple studies have found that transmission of SARS-CoV-2 via contaminated surfaces, or fomites, is relatively rare compared to respiratory transmission via droplets or aerosols. Despite the evidence supporting respiratory exposure as the overwhelming driver of community transmission, numerous public health entities, including the WHO and US CDC, continue to emphasize the importance of surface decontamination, which can cause confusion among the public regarding transmission risk and appropriate protective measures. Notably, surface decontamination efforts, while highly visible and easy to recognize, are costly and likely not effective means of reducing transmission risk. The editorial calls for increased focus on improving ventilation and air filtration capacity to reduce respiratory exposure. Additionally, proper physical distancing and face mask use remain key tools in mitigating exposure and transmission risk for individuals.

The key to reducing the risk of symptomatic infection, especially moderate to severe illness and death appears to be vaccination.

While vaccination clearly reduces the risk of severe illness and death, we do not yet know whether or how much vaccination reduces the risk of carrying and transmitting the virus. So even after vaccination, an asymptomatic or minimally symptomatic person can still transmit the disease to others.

50-60% of viral transmission appears to be from asymptomatic individuals. So wearing a mask, social distancing, and avoiding unventilated crowded indoor spaces remains extremely important.

DOUBLE MASKING IS MORE EFFECTIVE THAN SINGLE MASKS.

A TRIPLE LAYER MASK OF TIGHTLY WOVEN FABRIC IS MORE EFFECTIVE THAN a SINGLE OR DOUBLE LAYER MASK.

N95 MASKS ARE MOST EFFECTIVE BUT THEY MUST FIT THE FACE WITH A TIGHT, SNUG FIT. 

TO IMRPOVE THE BARRIER FUNCTION OF MASKS WEAR A SNUG FABRIC MASK OVER A SURGICAL MASK OR OVER AN N-95. THIS WILL PROTECT BOTH THE WEARER AND THOSE AROUND THE WEARER. The fabric mask over a surgical or N-95 mask provides two mechanisms of protection. It adds an extra layer and it provides for a tighter fit of the underlying mask.

Doctors and nurses in hospitals and clinics often wear a surgical mask over an N-95. 

Face shields do not protect you or those around you from infection. Face shields and goggles (more so) likely decrease the risk of infection transmitted from aerosols that hit your eyes but do nothing for the most important mechanism of spread, breathing aerosols or droplets into your nose. Aerosols spread around a face shield into your nose. 

Think about smelling the pleasant odors of food cooking in a kitchen. Face shields will not block those aerosolized food vapors from entering your nose, but tightly fitting masks will do it to some degree.

SARS-CoV-2 virus is at least 10 times more lethal than an “average” case of influenza. Newer circulating variants have mutations that have probably increased the mortality rate.

SARS-CoV-2 is at least 10 times more easily transmitted compared to most respiratory viruses. Newer circulating variants have definitely increased ease of transmission by at least 30%. As a result, herd immunity will likely require 85-90% vaccination of a given population.

10 times 10 equals 100 TIMES MORE SERIOUS.

In addition, compared to other respiratory viruses, this virus will more frequently cause long lasting or even permanent damage and disability involving one or more organs (heart, lung, kidney, brain). Long-COVID can occur following minimally symptomatic illness and even after asymptomatic illness.

This virus is unique in that TRANSMISSION OCCURS MOST FREQUENTLY FROM ASSYMPTOMATIC INDIVIDUALS.

This occurs for two reasons.

1. Unlike most other respiratory viruses, there is a long time from the onset of when a person becomes infectious to when they become symptomatic. (an average of 5 days)

2. Some individuals never develop symptoms but are still highly infectious for up to 2 weeks.

Restaurants, bars, churches, meeting rooms, cafeterias, parties in closed spaces are situations for SUPERSPREADER EVENTS. An this includes SUPER BOWL PARTIES.

Studies in hospitals show that transmission to health care workers occurs most frequently in the cafeteria and in meeting rooms, not at the bedside where providers are wearing PPE.

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. (read this Open Letter)
  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/)

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

Vitamin D for All, the time is right

2 Replies

On Dec 7, 2020 a group of more than 100 scientists signed a letter recommending that governmental agencies and major medical organizations endorse their recommendation for universal Vitamin D supplementation at adequate doses in order to decrease the risk of COVID-19 infection and death.

https://vitamindforall.org/letter.html

The letter cites multiple converging sources of data from several studies that should no longer be ignored.

“To all governments, public health officials, doctors, and healthcare workers,
[Residents of the USA: Text “VitaminDforAll” to 50409 to send this to your state’s governor.]
Research shows low vitamin D levels almost certainly promote COVID-19 infections, hospitalizations, and deaths. Given its safety, we call for immediate widespread increased vitamin D intakes .
Vitamin D modulates thousands of genes and many aspects of immune function, both innate and adaptive. The scientific evidence shows that:
● Higher vitamin D blood levels are associated with lower rates of SARS-CoV-2 infection.
● Higher D levels are associated with lower risk of a severe case (hospitalization, ICU, or death).
● Intervention studies (including RCTs) indicate that vitamin D can be a very effective treatment.
● Many papers reveal several biological mechanisms by which vitamin D influences COVID-19.
● Causal inference modelling, Hill’s criteria, the intervention studies & the biological mechanisms indicate that vitamin D’s influence on COVID-19 is very likely causal , not just correlation.“

I have previously discussed the relationship between low Vitamin D levels and COVID-19 infection.

https://practical-evolutionary-health.com/2020/05/02/covid-19-link-to-vitamin-d-status-should-doctors-prescribe-sunshine/

Since that post several more studies have been published strengthening the evidence that low levels of Vitamin D are not only ASSOCIATED with increased risk of infection, severe illness and death from COVID-19, but that this relationship is CAUSATIVE.

80% of patients requiring ICU care for COVID-19 infection have low vitamin D levels (25-OH Vitamin D levels less than 30 ng/ml)

“The data strongly suggests that vitamin D is the safest, easiest, and most important anti-pandemic measure the world is failing to prioritize,” says Karl Pfleger, Ph.D., biotech investor, former Google data scientist, and one of the organizers of VitaminDforAll.org.

More than 80 percent of COVID-19 patients are deficient in Vitamin D, studies show.

But how much vitamin D should an adult take and in what form?

As discussed in the letter, 3875 IU (97 micrograms) of Vitamin D3 daily is required for 97.5% of adults to reach a level of 20 ng/ml. 6200 IU (155 mcg) are required for 97.5% of adults to reach a level of 30 ng/ml. These doses far exceed the RDA (minimum daily requirement) necessary to prevent rickets.

On a sunny day, not too far from the equator, adult humans are capable of generating 10,000 units of vitamin D per day from the interaction of sunlight with skin. Human studies have demonstrated NO TOXICITY with daily supplementation of 10,000 units Vitamin D3 per day. Because of the risks of skin cancer, common use of sun block, distance from the equator, and a decrease in the ability of humans to make vitamin D from sunlight as we age, too many people have chronically low levels.

Vitamin D is a fat soluble vitamin. On a given daily dose it takes about 3 months to reach a steady state (stable tissue levels).

The point of that open letter and similar letters which have been published in major medical journals is the following. There exists today enough data to support universal supplementation with safe doses of Vitamin D3, well above the RDA, in order to decrease the risk of COVID-19 infection, risk of severe illness, and risk of death with the infection. Any further delay, waiting for more data is senseless. The risk benefit calculation based on present data is a “no-brainer”.

My wife and I have been supplementing with 4000 IU per day. Fauci is reported to be taking 6000 IU per day. We take it with food in order to maximize absorption. Our levels have been measured. Our levels are >30 ng/ml, <40 ng/ml on this dose. These are protective levels.

The amount of supplementation necessary to achieve these levels varies from person to person, season to season, and varies with distance from the equator. Some individuals will require less, some more to achieve levels above 30 ng/ml. But adults can safely take the daily amount recommended in VitaminDforall, http://HTML version.

The suggested protocol for those not already receiving the recommended intake is 10,000 IU (250mcg) daily for 2-3 weeks (or until achieving 30ng/ml if undergoing testing), followed by taking 2000-4000 IU daily thereafter.

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. (read this Open Letter)
  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/)

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

Chronic Inflammation, the silent killer

1 Reply

I was recently interviewed by a health blogger for his podcast. The topic was chronic inflammation. Here it is.

I prepared some notes for the interview. Here are the questions and answers.

What made you so interested in the topic of chronic inflammation?

Interest in chronic inflammation:

  • Emerging evidence, source of most chronic disease including mental health (depression, etc.) is inflammation
  • family health issues experience personally
  • health care policy interest since graduate school
  •  First started to question USDA dietary advice after reading GOOD CALORIES, BAD CALORIES, by Gary Taubes,
  • Experienced Statin myopathy, researched statin drugs, bad data, financial conflicts of interest. Sought alternative approaches to Coronary Artery Disease prevention.
  • In USA, Profit driven health care system evolved from more benign not-for-profit earlier system in medical insurance and hospital system. Drug and surgery oriented. Corporate ownership of multiple hospitals, concentration of wealth and power in the industry and in society in general
  • Saw this every day: growing obesity, Metabolic Syndrome, DMII, auto-immune disease. Root causes NOT ADDRESSED.
  • While recovering from surgery attended on line functional medicine conference on auto-immune disease, covering diet, sleep, exercise, sunshine, Vitamin D, environmental toxins, gut dysbiosis, intestinal permeability (THE GATEWAY TO AUTOIMMUNITY IS THROUGH THE GUT).
  • Introduced to EVOLUTIONARY BIOLOGY and Paleo Diet by my son

What diseases does chronic inflammation typically lead to? 

  • Cancer
  • Diabetes
  • Obesity epidemic, DIABESITY
  • Hypertension
  • Metabolic Syndrome (3/5: HTN, insulin resistance/high blood sugar, abdominal obesity, high TGs, low HDL),
  • Autoimmune diseases
  • Degenerative arthritis
  • Neurodegenerative disorders (dementia, Parkinson’s, neuropathy, multiple sclerosis)
  • Works of Dale Bredesen (dementia, “The End of Alzheimer’s”), Ron Perlmutter (Grain Brain), Terry Wahls (The Wahls protocol for MS), all FUNCTIONAL MEDICINE looking at root cause of illness, common-overlapping threads.
  • Interplay between sleep, circadian rhythm, exercise, sunlight, stress, environmental toxins, diet, processed foods, nutritional deficiency, gut microbiome, endocrine disruptors, intestinal permeability, oral and skin microbiome, social disruptors, GUT BRAIN AXIS. These are all part of one large ECOSYSTEM.
  • Positive and negative feedback systems requiring a SYSTEMS ENGINEERING approach to understanding root causes.
  • Butyrate is the preferred substrate for colonocytes, providing 60-70% of the energy requirements for colonic epithelial cells1,2. Butyrate suppresses colonic inflammation,3 is immunoregulatory in the gut,4 and improves gut barrier permeability by accelerating assembly of tight junction proteins.5,6
  • Improves insulin sensitivity, increase energy expenditure, reduce adiposity, increases satiety hormones,
  • HDAC activity inhibitor, PROTECTS GENES from removal of necessary acetyl groups.
  • Butyrate also influences the mucus layer. A healthy colonic epithelium is coated in a double layer of mucus. The thick, inner layer is dense and largely devoid of microbes, protecting the epithelium from contact with commensals and pathogens alike. The loose, outer layer of mucus is home to many bacteria, some of which feed on the glycoproteins of the outer mucus layer itself. Both of these mucus layers are organized by the MUC2 mucin protein, which is secreted by goblet cells in the epithelium. Supplementation of physiological concentrations of butyrate has been shown to increase MUC2 gene expression and MUC2 secretion in a human goblet cell line.7,8

What are the population groups which have higher risk of chronic inflammation? 

  • Obese
  • Sedentary
  • Poor-urban-polluted environment dwelling (air, water, noise, crowding, violence, racism, oppression)
  • Divergence from ancestral evolutionary biology
  • Working environment: indoors, polluted, oppressive supervisors, no sunlight, noise pollution, air pollution, toxic social situations, repetitive motion, bad ergonomics,
  • night shift, disruption of circadian rhythm
  • both parents working, no time for real food and family interaction, supervision of children.
  • screen time- sedentary behavior, lack of outdoor activity
  • Stress of social inequality, food insecurity, violent neighborhoods, nutritional deserts

What are the “danger signs” or typical symptoms which may signal a chronic inflammation? 

DANGER SIGNS:

  • Waistline (waist to height ratio, BMI)
  • Sarcopenia (muscle as an endocrine organ)
  • Sleep disturbance
  • Pain
  • Headaches
  • Depression
  • Lack of joy.
  • Brain fog, fatigue

What are the typical biomarkers of chronic inflammation?

  • METABOLIC SYNDROME (3 or more of the following: high blood pressure, elevated blood sugar, elevated Triglycerides, low HDL, obesity)
  • CRP predictive of cardiovascular events,
  • ESR associated with arthritis
  • Stress hormones (morning cortisol levels)
  • Resting Heart Rate and Heart Rate Variability

What are the typical sources of systemic chronic inflammation?

Sources of Chronic Inflammation:

Diet

  • N6/N3 FA ratio determined by too much Refined Easily Oxidized Vegetable Oils, not enough marine sources of N3 FA,  grain fed vs grass fed/finished ruminant meat. Loren Cordain research wild game FA composition = grass fed. Margarine vs Butter. Fried foods using Vegetable oils. Oxidized fats/oils, oxy-sterols in diet.
  • Sugar excess leading to insulin resistance
  • Refined carbs leading to insulin resistance (dense acellular….)
  • Disturbance of gut  microbiome from poor nutrition (sugar, refined carbs and vegetable oils all disrupt the microbiome)
  • Gut brain axis.
  • Food ADDITIVES AND PRESERVATIVES
  • Trans Fats (finally banned)

Endocrine disruptors/ BIOACCUMULATION

  • Plastics (microparticles in our fish, food and bottled water)
  • Plastic breakdown products
  • Phthalates added to plastics to increase flexibility ( also pill coatings, binders, dispersants, film formers, personal care products, perfumes, detergents, surfactants, packaging, children’s toys, shower curtains, floor tiles, vinyl upholstery, it is everywhere) 8.4 million tons of plasticizers produced annually. EWG.org
  • Pesticides, herbicides, glyphosate (Monsanto), DIRTY DOZEN, CLEAN FIFTEEN EWG.org
  • Medications
  • ABSORBED skin, eat, drink, breath,
  • BPS is as bad as the BPA it replaced
  • Polychlorinated biphenyls used in INDUSTRIAL COOLANTS AND LUBRICANTS
  • Flame retardants (PBDEs, polybrominated dipheyl ethers) are ubiquitous in furniture and children’s clothing. Also linked to autoimmune disease
  • Dioxins
  • PAHs (polycyclic aromatic hydrocarbons
  • Sunblock
  • CUMULATIVE BURDEN, INTERACTIONS, SYNERGY?

SLEEP DEPRIVATION CHRONIC IN OUR SOCIETY

Eating late vs time restricted eating

Gut Microbiome disrupted by

  • 1/3 of prescribed medications disrupt the microbiome AND increase intestinal permeability
  • Stress
  • Sleep deprivation
  • Sugar
  • Refined carbs
  • Refined veg oils
  • Over exercise and Under exercise, both are bad.
  • Environmental toxins

Gut dysbiosis and infections include (often chronic, low grade, not diagnosed)

  • Pathogenic bacteria, infection or overgrowth/imbalance
  • SIBO
  • Parasites
  • Viruses
  • BAD bugs > good bugs
  • Good bugs make vitamins and SCFAs required for colonocyte energy
  • Gut-Brain axis huge topic, VAGUS NERVE COMMUNICATION both ways, SCFA in gut and in CIRCULATION (butyrate, propionate, acetate), NEUROTRANSMITTER PRODUCTION (SEROTONIN, OTHERS), enterochromaffin cells producing > 30 peptides.
  • Overuse of antibiotics in medicine
  • AND use of antibiotics in raising our food.
  • Vaginal delivery vs C-section
  • Breast feeding vs bottle feeding

INCREASED INTESTINAL PERMEABILITY:

  • Caused by all factors above
  • Leads to higher levels of circulating LPS-endotoxin, bacterial products that create an immune-inflammatory response.
  • Incompletely digested proteins with AA sequences overlapping our own tissue causing autoimmunity/inflammation through molecular mimicry

Heavy Metal toxicity

  • Lead
  • Mercury
  • Cadmium
  • Arsenic

MOLD TOXICITY (> 400 identified mycotoxins, can cause dementia, asthma, allergies, auto-immunity)

  • At home
  • At work

What are the most efficient natural (non-medication) ways to address chronic inflammation?

  • Anti-inflammatory Diet, real whole food that our ancestors ate through evolutionary history (grass fed/finished ruminant meat, free range poultry, antibiotic free, and pesticide free food, wild seafood (low mercury varieties), organic vegetables and fruit, nuts, fermented foods, eggs)
  • Low mercury fish and seafood for omega three fatty acids
  • Sleep hygiene
  • Exercise, not too much, not too little, rest days, out of doors, resistance training, walking, yoga, Pilates, tai chi, chi gong, dancing, PLAYING!!!!!!!!!!!!!
  • Stress reduction: meditation, mindful living, forest bathing, sunlight, Playing, music, praying, SOCIAL CONNECTION, laughter, comedy, quit the toxic job, quit the toxic relationship, SAUNA/SWEAT, heat shock proteins, exercise
  • Vitamin D, sunshine, check levels
  • PLAY, PLAY, PLAY, LAUGH, DANCE, ENJOY, LOVE
  • Be aware of potential dangers of EMF, WiFi, hand held devices, blue tooth headphones.
  • Address environmental justice
  • Address social inequality, food insecurity
  • Tobacco addiction
  • Ethanol
  • Other substance abuse
  • Agricultural subsidies in US distort the food supply
  • Loss of soil threatens food supply
  • Suppression of science (global warming, environment, etc.,) worsens environmental degradation, creating an EXISTENTIAL THREAT.
  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.
  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. 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/)

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