Dr. Roger Seheult from MedCram on COVID-19 Vaccines, Vitamin D, and Heat Hydrotherapy

hello everyone welcome back to another episode of the found my fitness podcast i am uh very excited today we're going to be talking about covid19 um and it's it's it's a topic that's on all of our minds right now and has been for the last almost a year pretty much and my guest today is is someone that in my opinion has been a real important voice throughout the kova 9 pandemic his name is dr roger schwelt and he is a quadruple board-certified physician he's certified in internal medicine in critical care medicine in pulmonary diseases as well as sleep medicine but in addition to treating patients and also teaching medical students in a classical setting like a classroom he also runs a popular and very very informative youtube channel where he educates not only medical students but the broader public in general and his youtube channel is uh called medcramp videos and this is where i discovered uh dr schwelt he has been covering the kobat 9 19 pandemic pretty much since the beginning and he is he has been someone that has really done a fantastic job diving into the scientific literature being very comprehensive and uncovering just a wide array of very important topics related to this pandemic so i'm very excited to have roger on the show today and to discuss you know all things covered 19 roger and i share a few passions in addition to educating the public we also share passions about um you know scholarly work and diving into the literature and trying to you know answer questions and answer important questions and find good data to you know support um hypotheses so uh roger can you tell us a little bit about i mean how did you how is you know you've you've been covering cover 19 since march you know 2020 um and you know you how is how have things evolved for you in terms of covering this pandemic um and and you and i were chatting actually a little bit on the phone a few days ago and you were telling me um sort of what got you into this how you you know were in in the trenches out there and decided to sort of dive into the literature for certain reasons um maybe we could talk a little bit about that yeah so thanks very much uh dr patrick for having me on the show uh so this all started back when i was well i mean i could go for far back but i've always had a passion for teaching and taking things that are complicated and making them easy and understandable and all through my college medical school residency and now as a assistant professor at a couple medical schools that's what i do and one day i had the honor of having a pa student a physician assistant student that would change my life it's not every day that a student changes your life it's usually a teacher that changes your life and kyle kyle allred was he's the other half of medcram and he happened to be my pa student for a month and he he said dr schwell people don't go to the library students don't go to the library check out articles like you know i used to do they they go to youtube they go to google and they google the question they have and they look for the shortest video they can find and so he he saw a real need there because as they go through the pa program which is a two-year program you know sometimes they don't get all of the education that they feel that they need to get they have to do a lot of studying on their own and it's it's very time constraining to go and check all of these things out long story short is we started making videos about medical topics so copd congestive heart failure pneumonia asthma and we started posting them on our youtube channel and we've gotten up to you know a few hundred thousand subscriptions we were doing some videos that were very helpful and then coronavirus hit and uh one day we decided to do a coronavirus video this was probably in late february early march and it just exploded because here was this virus that was basically taking over in china and people wanted to know about it people were concerned about it and people wanted to know more and so instead of the world looking at uh you know movie stars or sports stars they were now for the first time looking at people like you and me rhonda people who had been working in medicine and nutrition and and uh medicine and science and really there was a lack of communication i mean we have whole tv shows on sports about how to communicate what's happening in the world of sports and and we have whole infrastructures for that we don't have that for medicine and science and so it really put a lot of people like myself and a number of other people like myself and you um on the hot seat to describe this to millions and millions of people what is it that's really going on and and really the question was begged is what do we do about it and that's sort of changed our lives and what do you like do you feel like earlier on um your your your thoughts about you know the pandemic have um changed since since you know everything that's you know happened since you know eight or nine months ago um in terms of prevention and um treatment and you know what what the data out there suggests like how has that evolved uh for for you in terms of you're also in the in the hospital treating patients as well yeah it's you know i grew up in this the scientific world of you know the hierarchy of evidence so you've got epidemiological evidence case control studies but really the thing that you need to have to be able to look a patient in the face and say this is going to help you is a randomized controlled trial and those type of trials take a long time they take a long time and the problem in this is that the system that we've set up of randomized controlled trials applications to the fda these are great for medicaid for diseases and conditions that are with us chronically and that moves slowly but they're not adequately designed to really help the majority people in a worldwide pandemic because people are dying very very quickly and you want to come up with answers very very fast and these things take time so that's one thing that i learned very very quickly is that if you want to try to save lives and you know all of us are look at this from a different point of view i guess i'm coming from the point of view of yeah i understand the ivory towers i understand the people at the fdi i understand the people that want to that people are relying on them to say here's something that we've tested that looks good and it and it works but on the other hand i'm working in the trenches too so i'm looking family members in the face and they're looking at me and it's like what can i do for our loved one what is going to work and what we have to do is marry those two concepts together and come up with things i believe that may have plausibility to work but but if we're going to institute something if we're going to do something it's got to have very very low risk and so what you've seen is you've seen a wide variety of things now that have gone through the fda that probably never would have been approved under normal situation but because of the pandemic and the flexibility that we need to have we need to move quickly because as as things get out of hand more and more people are dying so for instance convalescent plasma was approved using early using emergency use authorization through the fda there was no controls in that study um so you that's just an example of of the type of things that we're doing we're moving quickly here we're in a pandemic and we have to be creative and we have to be understanding that this is not a this is not business as usual have you uh looked back in history to see i mean this isn't the first time our the world has dealt with a pandemic and there's always lessons to be learned when looking back in history um you know i think things repeat themselves right then you're not you're not always starting you know from scratch basically there's a lot you can learn from from the past oh absolutely i i'm i'm hoping we were gonna go there in this topic because there is so much that i have studied not to say that i'm an expert in this but just looking back at where we were just a hundred years ago is very informative in that and i think if we want to get into that what we've got to do is look at the disease itself so covid covet 19 and i think probably one of the the first things that somebody needs to understand when you think about covid is it's all about timing it's very important that you understand that there is an early portion of the disease and there is a late portion of the disease and the timeline that separates those two is really when you get pneumonia i think that's probably the best way to to make that demarcation early in the phase of coping 19 before you have pneumonia there's a certain set of of factors that are going on in the body we can get into detail what those are that make certain interventions uh more plausible and uh more efficacious and then there's the later phase of covet 19 where patients generally are hospitalized they're on oxygen and we see other types of interventions to be much more effective to give you an example of that steroids so dexamethasone that was a uk recovery trial that came out showed without a doubt that steroids improve well what they found was that patients who were not on oxygen so in other words early in the course of the disease did not benefit from steroids it was equivocal whereas those that were the sickest patients on the ventilator requiring high doses of oxygen seemed to be the ones that benefited the most from dexamethasone or steroids the flip of that was remdessevere so whereas steroids were very beneficial late in the course of the disease medications like remdessevere which are not in it it's not an anti-inflammatory but rather an antiviral it prevents the viral replication the opposite was found remdessevere was much more efficacious early in the course of the disease and not so much so for those patients on on the ventilator so when you talk it's not just like this this disease is a one fits all thing you've got covet no it's is it early or late covered so taking that into consideration um we can then go back and look and see what people did 100 years ago for these diseases because what people did in the hospitals a hundred years ago is nothing like what we're doing today i mean they did not have oxygen they did not have ventilators they had some some medications which we can talk about but what what i started to realize is that in a pandemic situation it's very very difficult to scale up production of any pharmacological agent as we're finding out now let's look at vaccination let's look at medications fortunately dexamethasone is dirt cheap and we've had it for a long time and we can we can manufacture the stuff pretty quickly but if you find any kind of pharmacological intervention be it hydroxychloroquine be it ivermectin we can we can talk about those things those things have to be scaled so rapidly and so it's a such high degree that as soon as you say this medication is efficacious you can't find it in the pharmacy it's it's it's gone and so what this has done as a as to me as an individual has really looked at plausible biochemically plausible rational efficacious remedies that that are not a cure-all that are not they're not good they're to fix you or protect you 100 percent but may in a population type of setting swing things enough so that we can we can deaden the blow of the pandemic and are you talking in a sense about lifestyle factors things that oh yeah absolutely absolutely so lifestyle factors um but not just lifestyle factors because what are you gonna do somebody who has not been practicing the proper lifestyle and now they get cove in 19. what do they do it's too late for them to institute lifestyle changes that are really long lasting but what do they do and i think there is a science behind some of the things that that we can do and you know vitamin d we talked about vitamin d in the past and and now in the future vitamin d has been a long story you've been talking about vitamin d longer than i have and there are other things as well things that that are actually have some scientific plausibility which i i'd love to talk about you know so again like what we've been talking about rhonda it's it's an all of the above type of thing it's not just any one thing that's that's going to help it's like for instance when you go to the operating room right we want to prevent infections and so we don't think that just the doctor or the surgeon wearing the mask is going to solve everything we also have a negative pressure or a positive pressure uh operating room and we make sure that we use betadine on or chloraprep on the incision we're doing multiple things because nothing particularly by itself is going to be effective and so some of the stuff we've been talking about today like hydrotherapy or we'll talk about vitamin d none of those things by themselves is going to you know wipe out the the pandemic we have to do all of the other things that we know work like wearing masks you know over our nose and our face and uh and that's the other issue too is is we're seeing a lot of this people are in homes and maybe it's their eight-year-old that's positive for cove what do they do they can't just send their eight-year-old down the street and have them go to a motel so what do you do in the home uh and that just made me think of something else because the cdc's just come out now with updated information about what to do in terms of ventilation so the key in preventing yourself from getting covet 19 is to make sure that you know you're not getting it from somebody directly from like large sputum or droplets so you want to make sure that you're wearing a mask that they're wearing a mask that you're distanced but also realize that if you're in a room that's stagnant wearing a mask is not going to be 100 effective because it's kind of like smoking right somebody's smoking on the other side of the room you may not smell it but if you're in there for long enough that smoke is going to fill up the room and so what's really important is ventilation now that may be hard to do in a you know that may be difficult to do in the wintertime when it's cold outside but as much as possible even just cracking the window a few inches if you can do it and maybe dressing more warmly having ventilation in closed spaces can really do a lot so it's all of the above it's it's the mask wearing it's the it's the distancing it's to make sure that you're not in an enclosed space for a long period of time with other people you know interestingly you might wonder why people don't get the virus when they're on a plane that's a closed space and people are wearing masks well you may not know this but they do they do air changes like tenfold every hour and all of that air is going through hepa filters and so the virus gets trapped and that's why it works as people are on planes for five six hours you know going across the the continent they're wearing masks but they're not getting coveted 19 you might find a few examples where people might get it but generally speaking it's very successful and why is that it's because of ventilation and so all of these things put together is is really what the answer so following the recommendations following what the cdc says but here are some other things that we've talked about today that may also be beneficial so i just want to make sure that everyone's clear on that absolutely i think it's it's super important to um to keep that in mind that wearing a mask and social distancing and um you know washing your hands of course as well um and ventilation are really uh important and and definitely um there's been so many studies now with mask squaring too right i mean we're even just you know doesn't have to be an n95 mask i mean even you know someone wearing a cloth mask it can both protect um you from infecting others and also can actually filter out some to some degree some particles that are you know you won't be exposed to as many viral particles as if there were no mask even if it's not a super high quality and 95 mask you know filtering out particles so i find i found i found some of those studies to be reassuring at least where it's like okay well even you know people wearing any kind of masks you know right helps so yeah thank you thank you for bringing that up again dr schwelt let's dive into vitamin d um you know as it's definitely a passion of mine um i'm i'm a bit of an enthusiast you know but i i've published a couple of peer-reviewed studies uh back in 2014 and 15 and so you know i've been i've been very familiar with the vitamin d literature for for many years and um you know so when this pandemic first started i was already familiar with the role of vitamin d and the immune system and also in preventing respiratory diseases and randomized control trials showing that but maybe you can kind of you've you've done a fantastic job covering the role of vitamin d and cobra 19 and early on as well you were um you were out there champion you know that the vitamin d may play an important role and you looked at you know maybe we can talk about some of the observational studies and what the limitations are of those and also some of the very very preliminary you know pilot randomized control trials that have been done but maybe just start with some of the basics not everyone realizes that vitamin d can be a little uh the name can be a little uh deceiving you're absolutely right and it's one of the first things i and i know i'm preaching to the choir here those that that have watched you know that vitamin d is is so much more than just a vitamin but i would i would encourage anybody who is interested in this is just just google vitamin d structure and look at the actual chemical structure of vitamin d you know i got my bachelor's in chemistry so that's the first thing that i naturally do is you can tell a lot yeah good yeah so yeah exactly so you know that uh that if you look at the structure of vitamin d it is very similar to the structure of cortisol of the structure of testosterone of estrogen of progesterone and what do we know about all of these other steroid hormones they go directly into the nucleus of the cell where they affect transcription of protein factors and depending on the cell type it's going to have a different effect so so already right off the bat you can see that vitamin d is doing something very different than what we would think of as just a vitamin where you need a cofactor to have an enzyme do a to b it's much more nuanced than that and very early on the the the studies on vitamin d were involving calcium bone metabolism and so they came up with all of these things because they didn't know what else vitamin d did really i mean they had some idea but they came up with these standards oh you need so much vitamin d for your bones to do whatever it needs to do in the calcium and so it's the analogy i like to use is like you know you're you're baking something right and you put so much flour into the recipe it's as if to say that's the only thing that flour is good for is this one recipe and that if you use flour for anything else that's exactly the amount of flour that you have to use for any other recipe well that's nonsense of course i mean we know that we need a certain amount of vitamin d for proper bone metabolism but why does that carry that that's the amount of vitamin d we need for a proper immune function i mean none of those things are are there we have all of these standards about how much we need we'll talk a little bit about the about the observational studies but vitamin d is not just a vitamin it literally falls more into hormonal i mean think about addison's disease addison's disease is where you have antibodies that attack the adrenal glands this tiny little gland that sits on top of your kidneys the purpose of that adrenal gland is to make cortisol aldosterone androgens these things are essential in fact if people lose their adrenal glands they'll die because they don't have enough cortisol cortisol is essential for just the regular running of the body and here we have this thing called vitamin d the problem is we don't have a gland that makes vitamin d we have the skin right so the skin through uh through the sun and ultraviolet b radiation which barely penetrates through the epidermis it gets down to the dermis where the where the actual uh starting product is and so if you don't get enough of this you are going to be lacking in a whole host of things so let's talk a little bit about what we found and you know prior prior to uh prior to covet 19 we had some very good data on vitamin d there was a a wonderful meta-analysis what's in a meta-analysis where they take a bunch of studies they sort of chop them up put it through a grinder and they they look and see what the overall is so they can get a much bigger and much bigger subject number and martino who is the the lead author on that british medical journal meta analysis that was done a number of years ago now showed that supplementation with vitamin d decreased acute chest infections by 50 significantly uh in that study also in the the long aging health study called tilda in in ireland showed that vitamin d supplementation was beneficial so we knew that there was immune properties they found vitamin d receptors in the immune cells and so all of this stuff is emerging and then and then we get to covid and we start to see some really interesting studies coming out showing an association now that's an association not necessarily causation between a lot of the same things that we see in covid we see in vitamin d deficiency so what do we see the older you are the more apt you are to get vitamin d deficiencies because your skin is not as effective at turning at making vitamin d and we saw there was an age predilection in covet 19. what about race we saw that race particularly darker skinned people were affected more in encover 19 and that's that's not just you could say well there's some confounders there right because uh people who are ethnically darker may not have access to healthcare well this carried even in those countries where they were socialized medicine where everybody had access to health care which doesn't erase that completely but it was still a very strong association we also saw it in not only in gender but also big time in bmi so the more obese you were the the less the vitamin d also there was less in terms or more morbidity in terms of covet 19. but all of that got flushed out in i think on a beautiful study that was done uh here in the united states that looked at 191 000 people and this was published by uh it was published in plus one the journal uh an article titled sars cov2 positivity rates associated with circulating 25 hydroxy vitamin d levels so let's back up right there and talk a little bit about metabolism you've got these cholesterol derivatives that get converted into vitamin d in the skin well then that has to go to the liver for a 25 hydroxyl group to be put on on one of the carbons now you've got 25 hydroxy vitamin d this is what we measure in your blood and then it gets converted into 125 dihydroxy vitamin d in the kidneys for metabolism or in the white blood cells where they need it there so we're looking at 25 hydroxy vitamin d that's the storage form of vitamin d and what they found was that as your levels as your levels started to drop below 50 nanograms per milliliter we started to see an increase in sars cov2 positivity rate and it didn't matter based on race gender geography or age all groups saw an increase in sars cov2 infections associated with a lower level of 25 hydroxy vitamin d the lower these levels went the higher the positivity rate and that was just the beginning i mean this this went on and on and on we no matter how you sliced it or diced it there was this very strong association of vitamin d deficiency with higher rates of covid higher sars cov2 positivity rates and higher admissions we see people being admitted to the hospital had lower rates than those that were had similar symptoms but were not stars kobe 2 positive and you know as you know just because you have an association doesn't tell you that you have causation the only way you could really find that out is by doing randomized controlled trials like we've talked about and and so you mentioned um admissions but also mortality weren't there some studies also showing that that patients that were more vitamin d deficient were more likely to have a severe case and even die versus ones that had higher vitamin d levels absolutely yeah so that they showed that there was a difference in mortality that there was a difference in which ones went on to need ventilators and so all of this so so the question wasn't was the vitamin d involved in the somehow the question was was vitamin d the causative role or vitamin d deficiency the causative role right and as you mentioned because these are observational studies um one could argue well maybe low vitamin d is just biomarking unhealthy in general right i mean and and this is where um as you mentioned randomized control trials are really key but there's another type of study that i love to cite and talk about because um it's a way as you had mentioned previously randomized control trials are very very expensive to do they're very difficult they're they you know they take a long time it it's it's a challenge um so another um way of measuring more of a causative role of maybe you know of of certain factors and and particularly in this case lifestyle factors or something that you know i call vitamin d a lifestyle because you're making it you know from the sun um they're called mendelian randomization studies and essentially what they do is they measure so everyone has you know different variations in the sequence of dna in their genes and these variations often are just a change in one dna nucleotide which is called a single nucleotide polymorphism or a snip for short as you know but for people listening and watching there are many different variations in genes that convert for example 25 hydroxy vitamin d the major circulating metabolite vitamin d into 125 hydroxy vitamin d which is the active steroid hormone and these changes in just one nucleotide of dna and these genes um are associated with lower circulating levels of 25 hydroxy vitamin d uh because you know it's just it's just that you know different genes are doing different things and sometimes genes get less active and sometimes they're more active based on this you know sequence change um so it's well known that these certain snips are associated with uh lower circulating 25 hydroxy vitamin d levels and so there have been meta analyses looking at people that have this snip didn't measure vitamin d levels at all it's already known they have lower circulating levels so you can't say oh you know they're you're just measuring their low vitamin d that's biomarking another health status this is just genetics we're just looking at a gene that's known to cause that and these people have a much higher mortality from respiratory tract infections they have a higher all-cause mortality they have a higher cancer mortality cardiovascular related mortalities is unchanged but respiratory tract infections are much higher um and so that mendelian randomization study i i love to to cite that because it really is establishing causation because it's not you know you're not just measuring vitamin d levels and go and and then saying well maybe they're low in vitamin d because they don't go out and exercise or maybe they're low in vitamin d because they're you know obese and and the you know vitamin d is less bioavailable which it is in obese individuals as you mentioned so the mendelian randomization studies are another sort of in addition to the randomized controlled trials i think another piece of evidence that hints towards possible causation of vitamin d being important for preventing respiratory tract mortality um as well oh that's amazing i i wasn't even aware of that that's uh that's a that's a great way of of showing causation um and and of course they are working on some uh pilot studies that are trying to show randomization but uh how how big of a study was that uh it was quite large um i don't recall off the top of my head i do have it linked in my notes i can i can pull it up and send you but um yeah this it's it's there's been other um snips in like the vitamin d receptor for example so children that have a single nucleotide polymorphism in the vitamin d receptor they also have a higher mortality from respiratory tract infections as well um you know so vitamin d as you mentioned you know it's a steroid hormone it's going into the nucleus it is you know it binds to the vitamin d receptor which then heterodimerizes with another receptor called the retinoid receptor and that complex you know goes in and and into the the nucleus where your dna is and it recognizes a very specific sequence of dna called a vitamin d response element and and these are in more than five percent of the protein encoding human genome i mean that's a lot of genes vitamin d is regulating in all sorts of tissues you know brain in the immune cells um you know and and other organs as well um so i i do think like you know thinking about mechanism and i know you've talked about you know the role looking you know underlying mechanisms how does vitamin d regulate the immune system i mean there's a variety of ways um and specifically it it's really interesting um and i'm getting off topic here i want to get to the pilot randomized controlled trials but are you aware of of the role vitamin d plays in the ace ii and renin angiotensin system i know there is a connection uh i was actually reading that uh just briefly i think you're the one that sent me the i need article remind myself we covered it back in um march or april i think we did i did a short little um q a podcast on it and it's really interesting you know much more about the iranian angiotensin system than i do as a as a medical practitioner which you know it obviously plays an important role in regulating blood pressure and fluid homeostasis and you know i think even in the lungs too uh but what's interesting about the vitamin d uh renin angiotensin system kind of it converges on the ace2 receptor which um as you know and probably most of the world is heard by now is how the sarge cove to vir virus enters into our cells it binds that receptor well what's been shown with sarge cove one is when the virus which also binds to the same receptor to get inside of the cell it binds to the receptor and it internalizes the receptor and down regulates ace2 which is not good because that is really important for this renin-angiotensin regulation um as you know dr schwelt so um that's been shown with stars cove one and what happens when the ace two gets down regulated lung injury acute lung injury um gets really bad um and and so there's been some animal studies that have found for example if you high dose with the active form of vitamin d the animals and then you cause acute lung injury ace2 goes down acute lung injury goes up in the placebo group but the vitamin d group it normalizes the ac2 levels so if you think about it you know another potential this is like this is a hypothesis of course uh another potential way of vitamin d could be playing an important role in this specific virus is through regulating ace2 levels and what's interesting is that there was just a very recent study that came out um ace2 the gene is it's located on the on the x chromosome and um women have two x chromosomes most of the time one of those x chromosomes the genes inactivated um but there are genes that escape that and ace two is one of those and so women have much higher levels of ace too and um so researchers are thinking this is protecting them from a more severe uh cobia 19 outcome because they're getting that that that ace2 levels like you know higher in terms of you'd think oh well more is two that means the virus is getting in and but actually biology always tricks you it always you know you always think one thing and then it's like this beautiful you know sort of complex scenario but um i'm digressing and i just kind of wanted to bounce that off you because you're such a scholar and i thought you probably would find that interesting and i certainly hope scientists are are testing that hypothesis because it seems very relevant yeah it does um not only that there's the human body is so complex as you say that there's so many connections the other aspect of uh angiotensin or ace ii i should say is that it um it gets rid of pro-oxidative uh products and it uh increases antioxidant products so for instance angiotensin ii and angiotensin one seven those are in balance and ace2 tries to keep those in balance but when a2 is knocked out by either sars cov2 or stars 1 the amount of oxidative stress goes up dramatically and what we see that that may play a role in terms of thrombosis so you have oxidative stress in the ace2 receptors of the endothelium of the vasculature that causes uh inflammatory stress oxidative stress that causes thrombosis and and that's where that happens as well so all of these things it seems as though we've got the dots uh connecting them requires very good randomized controlled trials but uh again like you said hypothesis driving type of uh studies that that may may answer that question that that was um very enlightening um i do remember reading about that and um wow i didn't know realize it played the role in the thrombosis as well um so that's that's that's super interesting um but as you mentioned yes randomized control trials are key and there have been um i've seen you know one stronger but small trial that was published um was it back in september that found this was at i think it was in was it spain perhaps yes yep it was uh it was october i've got it pulled up here october uh of 2020 and it was a spanish uh it was marta castillo who published he was the lead author on this one out of spain there was a little issues with the randomization so probably the effect was over uh overemphasized but if you look at the effects they were quite dramatic they're in the calcifedial group let's just back up a little bit what's calcifidial that's the name that we give to 25 hydroxy vitamin d so in this in this study they didn't give just vitamin d they gave the product of the metabolism in the liver of vitamin d now do you think that's important for someone that is undergoing let's say i mean if you're if you're so sick and maybe your liver is not working properly your kidneys aren't working i mean how are you going to convert these vitamin d metabolites into this steroid hormone right so um do you think it's important to give someone that more you know more downstream like an active form versus vitamin d3 for example exactly and so that's the question is whether because it takes some time for the vitamin d to be metabolized in the liver some i've seen some people say up to you know seven days it probably is a little bit less than that but when you have uh when you're giving vitamin d in the acute situation it doesn't really matter if you're just supplementing over a long period of time and you're hoping to prevent yourself from having a bad outcome with covet 19 but if you've already got copin 19 what what they may be saying here is that supplementing not with vitamin d the product prior to liver metabolism but in fact calcifedial 25 hydroxy vitamin d might be a more efficacious intervention and that's what they did in this study and you know another thing this sort of brings to my mind um you'd mentioned the the pre-pandemic studies looking at randomized control trials looking at the role of vitamin d supplementation in preventing respiratory tract infections uh i believe it was martinell the the senior author on that yes and what was so interesting about those meta analyses was that they found weekly doses daily doses worked but monthly doses did not in terms of protecting against acute respiratory tract infections that stuff yeah and i to me it's like we can't learn from past like there's something wrong we need you know so when you're designing a clinical trial you need to be familiar with literature and see oh there's these meta-analysis showing that monthly doses don't work maybe we shouldn't design the trial that way maybe we shouldn't just do one large dose which um i think i've seen a pre-print floating around uh for the for copen19 where there was one large dose and there was no effect yes um yeah you're referring to the uh the brazilian study where they gave 200 000 international units at the very beginning yes i don't believe it's peer reviewed yet in my mind i haven't seen it yet okay um this study though this spanish study where they gave something called calcified dial which is against 25 hydroxy and it's this is not an over-the-counter medication this is a prescription only it's usually prescribed by nephrologists in patients with renal disease that have very high pro you know procalcitonin and procalcitonin but parathyroid hormone levels and they gave it on day one they gave it on day i believe three and then uh again a day seven and what they found was in the calcifedial group there was only two percent that went to the intensive care unit whereas in the placebo group 50 of those went to the intensive care unit so that's a a very very marked number uh again there was i think the the british recently got together and looked at all of the data and you may have known they made a recommendation that there still was not enough evidence to uh cause supplementation to prevent covet 19. interestingly they discounted this spanish study because they felt that the the randomization was not good enough but there's been some mathematicians that have looked at this study and said that it would be impossible for that randomization to fully describe what happened in this study in other words they believed that there there was an effect of calcifidiol in this study and it seems very likely if we have as you mentioned meta analyses of many many many you know over 25 different randomized controlled trials showing vitamin d supplementation improves um prevents respiratory tract infections you know in people that are vitamin d deficient between 50 to 70 70 and even still had an effect in people that had normal sufficient levels of vitamin d maybe we can talk about what those are but what would make i mean of course you know viruses are different but i mean a respiratory tract infection you know to some degree there's got to be some common denominators right i mean so it would seem to me it would seem you know logical that something like vitamin d where in the united states you know 70 of the us population is categorized as vitamin d insufficient which uh defined as the by the endocrine society is less than 30 nanograms per milliliter and 30 of the u.s population is what is called vitamin d deficient so they have less than 20 nanograms per milliliter blood levels of 25 hydroxy vitamin d which is the majors you know circulating metabolite vitamin d so i mean you know it's it's the question becomes maybe we can talk a little bit about vitamin d supplementation and safety but is it really i mean you don't have to make a bold statement that it's going to prevent covet 19. i mean absolutely we should be following the cdc guidelines on social distancing on wearing masks on washing our hands and also you know as soon as they become available vaccinations but in addition to following the cdc guidelines it might be prudent to say it's probably important to become vitamin d sufficient in other words if we already have data that you know 70 of the u.s population uh you know has insufficient levels of vitamin d then clearly people need to take a vitamin d supplement and you know i think or maybe need to get their levels measured i mean the best way is to go to a doctor get your your vitamin d levels measured you know and then see what those are and then take a supplement to bring them up and i mean the reason i say that is because as you mentioned you know we make vitamin d in our skin but depending on where you live you know you said uvb radiation is is how we make it in the skin depending on where you live many parts of the year uh uvb radiation's not even hitting the atmosphere right exactly and so if you live above the 35th parallel which if you're in the united states that would be the southern border of tennessee or uh just a few miles north of us here in southern california you know most of the of the country lives above the 35th parallel which means that you're not going to get enough uvb radiation in the winter months to supplement or to keep elevated your your vitamin d levels sufficiently so you've got to take supplementation and and and sunscreen blocks uvb radiation most people are wearing sunscreen most people are indoors now work is you know we're on our computers we're not out we're not we're not an agrarian society like we used to be you know people aren't out in the sun all the time people are inside i mean if you look at um you know nhanes data over the past couple of decades you see vitamin d levels are steadily just going down down down down and i think that's because most people are now spending more time indoors um also as you mentioned um people like african americans people with darker skin have much lower levels of vitamin d in fact african americans this was enhanced nhanes data the most recent enhanced data that was published they're 30 times more likely to be vitamin d deficient than caucasians and the reason for that is because melanin is a natural sunscreen i mean it protects you from the burning rays of the sun so if you live in you know australia or closer to the equator you know somalia for example that's great because you're getting a lot of ubv exposure year round but when you take a person and migrate they migrate say they move from africa to new york city to chicago well it becomes a problem because you're much further from the equator and now you've got this natural sunscreen that helps you you know protect you from the burning rays of the sun and now you're living in a place where you're not getting as much sun and so there's a there was a study that came out of the university of chicago a few years ago that found african-americans in chicago have to stay in the sun six times as long as a caucasian to make the same amount of vitamin d yeah i believe it and and you know the other thing people say well if that's the case then uh then how come people are getting covet 19 in in sunny places in hot places for instance if you remember back in the early part of summer there was a huge epidemic in arizona and also in florida and texas well i mean if you think about it yeah there's a lot of sun but if you're inside you're not going to get exposed to the sun right you think people in arizona are going out in the sun in the summer dude it's like living in the winter when you're in it's summer i lived in tennessee for six years and i'm from southern california so summers i was used to spending on the beach when i went to graduate school um summers became like winter because i did not want to be outside it was like 95 degrees humidity hot i mean so i spent way more time inside in the summer in tennessee than i did in the winter in right and and here's the other thing too is that uvb barely gets through the atmosphere down to us and it does hit us when we're outside and it the sun's got to be pretty high up in the sky you go behind a piece of glass there's there's almost no uvb at all the only thing that's coming through is uva which is you know nasty ultraviolet radiation it makes your furniture uh you know fade your carpet fade and it gives you aging wrinkles on your skin so if you think that you're sitting by the window is going to give you some nice vitamin d you think again and clothing right clothing also blocks it you know so you know the question becomes why why is the vitamin d prevalent vitamin d insufficiency and deficiency is so prevalent um in our country and also you know in places like the uk where you said you know they're they're not finding enough evidence to recommend vitamin d to prevent cobalt well maybe that's a strong statement and you need more randomized control trials to make a uh extraordinary claim like that but you can still make a claim that it's probably in your best health interest to maintain good levels of vitamin d and that because we know vitamin d deficiency is so prevalent that it's probably best to get a vitamin d test and measure your levels and take a vitamin d supplement exactly and the thing that's uh that's a little confusing too is that a lot of these levels that we've come up with are are based on the endocrinological function of vitamin d with bone metabolism we don't know if that's the value that we need for uh for immunoimmunological functioning or covid what we do have some associative studies that seem to show at least in those studies that we talked about earlier where they took looked at 191 000 people that sars co-v2 rates started to go up once levels drop below 50. so that's that's an interesting number that's interesting there's there was a few um back in 2013 there was a meta-analyses published i don't know the author's name but the studies dated back from the 1960s to to the 2013 and it was looking at all cause mortality in association with vitamin d blood levels and it was found that you know levels somewhere between 40 to 60 or 70 like it was the lowest all-cause mortality so like like there was this sweet spot um you know and of course it's one of those things where you know associative studies are there's always the problems that people try to con you know correct for confounding factors and um but but the idea is to look and this is what you've done such a fantastic job you know with your scholarly work at medcram videos is looking at the whole body of evidence the the observational data the mechanistic data the case studies and you know if there are randomized controlled trials on the animal studies as well you know because that helps give us some insight on mechanism and of course you can't translate in animal study to humans but but if you take the whole body of data right everything together then you can begin to tell a story uh as well so um in terms of supplementation though you know it's the upper tolerable intake that's been set by the institute of medicine has been four thousand ius a day um and what about you know vitamin d is a fat soluble vitamin what about toxicity um toxicity uh there was a statement that i read that said that uh vitamin d is probably the least toxic fat soluble vitamin so there was a study where this uh this polish guy looked at uh polish scientists looked at the mayo clinics database and they looked at 20 000 people and we've talked about this in our in their video that we recently published one person had hypercalcemia out of those 20 000 and they had ranges people supplementing anywhere from zero to 55 000 units a day and really just one person and that person's vitamin d level if i recall correctly was up in the the 200 300 range that's nanograms per milliliter and that's hard to do yeah it's massive yeah i i remember reading a study and i'm sure you've seen this one where there was the long the long-term supplementation with 10 000 ius a day and it was really no no toxic effect and that was that was forgot how long term it was but yeah um yeah the other thing i that i've seen is that you know it's not a linear response curve so it as you go up in supplementation it's not like your nanograms per per milliliter are going to go up linearly what we notice actually is that the first thousand units that you supplement causes an increase of about four point eight to five uh nanograms per milliliter whereas when you get up to about fifteen twenty thirty thousand that uh each additional thousand goes up by about a tenth of that so it's it's a it's a non-linear relationship it's a as exponential but the reverse of exponential as you go up higher and higher the increment becomes uh less and less it's almost like you're saturating receptors if you will it's probably not the case but that's that's what it seems to be like do you measure vitamin d levels in your patients or is that something that's common in the hospitals you work in yes so we have been doing it uh it's it's problematic if you don't have a lab that does it quickly so you get the result back in two to three days which uh which you kind of want to know that up front so we will supplement and then wait for those levels to come back but uh most of them are are low and and there's been studies on this too that have shown that most of these patients specifically with covet are um are coming back positive they're are coming back with low vitamin d levels what they did in one study they wanted to see whether or not it was the symptoms that were caused in the low vitamin d so they they took these patients and they said okay anybody that has x y and z symptoms we're going to look at and then they figured out which ones were covered and which ones were coveted negative well the ones that were positive for covid and had the same symptoms had lower vitamin d levels than those people that had similar symptoms but were negative for covet so it's not just the symptoms of covid that's causing the low vitamin d levels it's something about covet itself that seems to be doing it wow so you guys are in your um in the icu where you're treating patients you guys are giving patients vitamin d oh yeah that that's that's great is that something um that that's being spread amongst hospitals do you do you know i hope so i'll tell you what we're doing based on the shade study this is another randomized controlled trial that came out of india and it showed basically when they supplemented patients in the hospital with sixty thousand units a day for seven days that there was an improvement by day twenty one in the number of coveted negative patients on testing now that's probably not the best uh surrogate because you know pcr picks up any little detectable fragment of of rna and and gives you a positivity it's a surrogate but there was it was like 60 versus 20 percent at week 3 were negative by by just supplementing with vitamin d the other thing that they looked at was fibrinogen which was a a marker of inflammation that was significantly lower as well so based on that study we don't have 60 000 units typically here in the hospital we have 50 000 so i figured the 50 versus 60 is going to be a very small difference and so that's currently what what i'm doing in my patients and i'm recommending to my colleagues to do the same we haven't seen any toxicity there was no toxicity in that randomized control trial either so you're kind of just assuming from right out the bat that most likely patients are low in vitamin d i mean which i think is a reasonable assumption considering and haines data showing that 70 of the us population is insufficient correct and if they're not it's it's probably not going to hurt them if we do it for just seven days right right well um i'm looking forward to more you know data on on vitamin d in terms of randomized control trials i only hope these randomized controlled trials are designed properly and you know there's so many there's so many factors when it comes to something that's nutrition related or something that you know you can make from the sun it's always important you know it's not like a drug when you do a randomized controlled trial with a drug a pharmaceutical you know drug people have zero levels of that in their body to start with you know you give them that drug or the placebo and it's obviously you know they're going from zero to something whereas with something like vitamin d and also with in nutrition in general well you have to measure things at baseline you have to get you have to get you have to quantify right you know you have to have something quantifiable and i've seen randomized controlled trials believe it or not with vitamin d where they don't measure vitamin d levels they just give them the supplement and it blows my mind um that that can even get past peer review or how do we design a trial that way i mean you know it's just it's adding to the confusion in my opinion so i'm hoping that because of the seriousness of this pandemic that you know people designing these trials are doing doing so carefully um you know like the fact that we we know from from previous data that one high monthly dose of vitamin d may not be enough may not do the job right and as you mentioned maybe that's because it doesn't bring their levels up because it's not happening in a linear way right yeah so so there was a great study that looked at that in france um you know apparently the practice was that every nursing home patient would get 80 000 international units of vitamin d every three months and uh when covet hit these patients were being admitted to the hospital they they asked a very interesting question what they did was they it was kind of a quasi randomized study as they were being admitted they would ask the question so how long has it been since you got your 80 000 international units of vitamin d and when they ran when they not randomized what they sorted them to those that had gotten it within the last 30 days to those that had gotten it past 30 days there was a statistically significant clinically significant difference between those that had gotten it recently and those that have gotten it more than a month out wow and do you ever have people just tell you well just go out in the sun more or uh you know eat eat some food that's high in vitamin d i mean what do you say to to people that might might say such a thing um well you don't know if it's working so i i was taking two and i'm i mean i'm not i'm not living at the north pole here i'm in southern california uh like you and i was taking 2 000 units a day and i wanted to get up above 50 because of some of that data that i showed so when when my levels were tested so me i work outside i i i'm i'm not i don't like working inside a lot so i go outside too i do gardening i you know like working around the garden stuff that plus 2 000 units in the middle of summer and i was at 48. wow so that that tells you that right that you may have to work a little bit harder than you think at getting your vitamin d levels up yeah and i think again depending on how much melon you have in your skin depending on your age you know you're anywhere between two or four times less likely to make as much as you were when you were younger you know depending on all that stuff are you wearing sunscreen where you live what time of year it is all those factors i mean so just to say go out in the sun more you know we're like what if you're an african-american living in chicago and it's november what are you going to do right now and in the middle of winter the sun's pretty low so it's it's probably there's not a lot of uvb probably that's coming through ultraviolet b radiation it's got to go through a lot more atmosphere to hit you when the sun is that low in the sky right exactly and the other thing is people think you can just get it from your diet and this is another sort of factor that i really like would like to address because you know the reality is um the the foods that have been first of all the food that's been fortified with vitamin d the most is milk and unfortunately you know there's a lot of people that are lactose intolerant and 75 of african americans are lactose intolerant and there have been studies that have shown that for example african american women that have a single nucleotide polymorphism in the lactase gene that allows them to um you know tolerate lactose they have much higher levels of vitamin d because they're drinking milk so fish fatty fish salmon you know like four ounces have close to 400 ius maybe but you know people aren't eating fish in the united states they're not i mean maybe in norway or japan um you know and of course omega-3 i mean is is also very important and i also think it's very important to get enough omega-3 particularly now because of the role omega-3 in uh inflammation and um you know there have been some interesting studies showing that uh omega-3 supplementation um there's been a meta-analysis showing that supplementation in hospitals like prevents icu stay or lowers ice use day prevents mortality and like by up to 60 percent um i think they were this was um para internal per how do you when they're giving it yeah the iv yeah they're giving it to the iv um as well as there's been other studies showing it helps prevent as i mentioned to you it was venous thrombosis yeah um so uh but but my point is vitamin d is in the fish most people aren't eating fish so um a supplement is it's really the easiest low-hanging fruit i mean as you mentioned it's really hard to get people to change their lifestyle you know we know for example that people with metabolic syndrome with type 2 diabetes that are that are obese high blood pressure like are have much you know higher risk of a severe cover 19 outcome right but to get someone to completely reverse your type 2 diabetes is a lot of work you know we know things that can do it in diet you know cut out the refined sugars and exercise and there are things that can can reverse type 2 diabetes um but that takes you know motivation you have to want to do that it takes a lot of effort and it takes some time um whereas you know i think most people can take a vitamin d supplement it's one of the cheapest i mean it's literally like a penny a pill it's one of the most affordable supplements ever and in my opinion one of the most important you know because of the widespread deficiency because of the way our society is now where we have migrated to other places you know where we're indoors much of the time and it's a very different world that we live in you know compared to you know a thousand years ago um you know or maybe that's too far back but you get my point um so yeah no there's so many things that are involved with it and i i'm of the opinion too just because of some my sleep background as well that i do believe that there is a benefit from actually getting out into the sun so i i i don't say that uh going out to the sun's the only way you can do it or should be the only way i think i believe in supplementation i supplement as well but there is something to be said for getting outside instead of fresh air and sunlight and allowing that light to hit the back of your retina it has wonderful effects in terms of getting your circadian rhythm on sync so yeah i i think i think one of the things that we need to learn about is it's not an ore it's an and it's an all of the above type of thing and uh just because you supplement doesn't mean you should go in the sun just because you go in the sun doesn't mean you shouldn't supplement oh i 100 agree thank you for bringing the circadian rhythm um up i mean that it's one of the things uh that i've noticed having early light bright light exposure and setting my circadian clock is one of the most important things that has helped me sleep better at night because my clock is set early yeah and you know my body starts to produce melatonin at a reasonable time as long as i don't have bright lights of blue light on in my in my house all night but um you're so you also are in the sleep uh medicine and you run us you are you you have um do you run a sleep clinic or you're involved in this industry i have a sleep clinic and i also am the medical director of a sleep lab as well so what are some of the things i mean sleep is also very important for immune function and um what are what are some of the things that uh you're you're helping your patients do with in terms of sleeping better and and helping um yeah so so sleep is a very complicated uh topic because everybody may have problems sleeping but it's for a myriad of different reasons uh it could be medical reasons could be just you know maladaptive behaviors but what the point i want to make is that sleep and the immune system are intimately connected we know for a fact that people who get more sleep before they get an immunization have a better immune response with higher antibody titers to for instance the flu vaccine we know that when people are challenged with a virus they actually did this study where they they put rhinovirus into students noses subjects noses on purpose uh you could you you know living on a college campus people do any study for for very little money so it's easy to get those kind of students but uh this is what they did they subjected them to rhinovirus and they put it into their nose and they waited to see how many people came down with uh with the common cold and when they look back and and saw what their sleep habits were it was a five to sevenfold difference if you looked at those people that got seven or more hours of sleep per night versus those that got less and whether or not they had a good sleep efficiency so sleep efficiency is how many hours you're actually sleeping divided by the number of hours that you're in bed and so you have good sleep efficiency you've got good hours of sleep so good quality good quantity your risk of getting any kind of virus like rhinovirus adenovirus those sorts of things are is cut by five to seven fold that's a massive number when you consider what we're trying to do to reduce the incidence of covet 19 right now with vaccinations and things of that nature that just a good night's sleep can have that much of an impact it's not a cure but it's a it certainly is somewhere to start that's that's a very robust difference i mean i i know i probably speak for many other people i know from personal experience absolutely a hundred percent if i get a bad night's sleep and i've been exposed to a virus it'll take me down um you know and and it it it this seems very relevant right now with vaccinations that you know sleep plays such an important role in the in the product the antibody titer and how many antibodies you're producing um but even in more general sense i mean you know the the fact that that sleep is so important for just immune function um so what is what do we know some of the mechanisms i mean one of the mechanisms that's involved uh has to do with the stickiness with how those immune cells stick to each other and that's regulated that's regulated by by you would probably not be surprised by g proteins and cyclic amp and second messenger systems and what we notice is that when you sleep more your cortisol levels are lower and cortisol of course is cortisol and epinephrine and all of these other beta adrenergic systems affect the g protein stimulate the g protein causes increasing cyclic amp in these immune cells and they make those uh those those proteins like the major histocompatibility complex one and two less sticky and so it impairs your immune system when you have higher levels of cortisol higher levels of stress and really interesting study um since you just mentioned the the the light exposure and helping with sleep i saw there was one study where people were exposed to 10 000 lux of light and i believe it was for like a significant period like six hours you know like where you're like literally like it's a weekend you're just you're outside at the beach or something you're you know outdoors um and it lowered their cortisol levels by 25 i think during the um the phase where it's not supposed to be high or something because cortisol obviously wakes you up i mean your cortisol is regulated in a circadian manner and it you know it's important for waking you up but the problem is is that people are having higher cortisol from you know psychological stress um you know from from from what are some other things that raise people's cortisol yeah oh so other things like sleep apnea that's a big one sleep apnea yeah sleep apnea basically just the lack of sleep tied to obesity what are some of the main practices that you tell your patients like what have you found some of the most robust practices for improving sleep like okay yes maybe the lowest hanging fruit too so yeah so like things that are lowest hanging fruit and things that are more robust so the most important time of sleep is the sleep that you get at the beginning of the night um there's two there's really two types of sleep uh that are the best at making you feel healthy and they are slow wave sleep which is right at the beginning of the night in fact this is the type of sleep that is associated with growth hormone secretion especially in children this is the if if there was ever the the fountain of youth this would be it growth hormone makes you feel younger makes you look younger i mean it's it's in fact we were giving growth hormone injections many years ago until we realized that it can cause problems because of where they were getting it from but that's another story but growth hormone and slow wave sleep at the beginning of the night is very very important yeah rem sleep is toward the end of the night that's when you dream and that's that's also a good part of sleep as well but nothing beats slow wave sleep with these large delta waves if you if you were to look at this on a on a a poly sonography so the most important time to sleep is really that time before midnight and there's a lot of research in the last four or five years that has been going into this holy grail of slow wave sleep and what happens at the beginning of night so with that being said think about what what's going on in the united states right now okay and over the last 50 years we've essentially turned night in today right if you've ever seen those satellite pictures of what the united states looks like at night it's lit up on both coasts and if you look at our area here in in southern california it's it's very bright it's probably one of the brightest in the nation uh probably only second to new york and the dc new york you know area but here's what's happening people are coming home later they're you know eating later staying up later they've got a lot of work to do and they're they're putting their faces in front of screens which is emitting light now what does that light do at that hour what that light does at that hour in just about everybody is it shifts the circadian rhythm and delays it so whereas you would feel sleepy normally at let's say nine or ten o'clock at night you're now gonna start to feel sleepy at 11 or 12 o'clock at night and so you don't go to bed until later so you would normally be waking up seven eight nine hours later because that's how much sleep you're really supposed to get but unfortunately that goes into eight nine o'clock in the morning and you're supposed to be already at work at your desk or you know now with covet you're at home working somewhere or because of the fact that there's so much density you've got to get up at four in the morning five in the morning to get in your car to do your two-hour commute to beat the traffic to get at your desk and so what we've done essentially over the last 50 years is we have sandwiched the amount of available hours that we have for sleep and what's cut off what's been cut off is that first part of the night before 12 o'clock where the best most restful part of the of the night is going to happen you know it's been said many times and from people hundreds of years ago i don't know how they knew this but over 100 years ago they said the most that that two hours of sleep before midnight is worth more than four hours of sleep after midnight and and the science is actually showing that to be true it's it's amazing so so that the the thing that i have found to be the two things i found to be most effective or maybe three in in making sure that i am not a night owl i mean some people there are there are genes that do control this and there are some people that are genetically they're night owls and there are there are some genes that actually allow people to get less sleep but those are sort of a lot more rare right um but what i have found for me is bright light exposure so you wake up in the morning and what do you what do most people do they want coffee because they're sleepy and they didn't get enough sleep and so they're trying to counter that with some caffeine right right maybe they should step outside step outside for 30 minutes maybe drink your coffee outside for a walk you know if it's cold out you know i you know drink your hot coffee and you know do some stretches or yoga or something but go outside and set that clock so that you're so that your circadian rhythm sets earlier so that you start making melatonin earlier however in order to make melatonin earlier um i previously um around our house we had these philips hue lights which basically you can program them to be to turn red at a certain time so red would be something that uh isn't as disruptive to melatonin production because as you know blue light is what disrupts it and so um you can program them to like let's say come on at 5 pm and so now all the lights in your house are red rather than bright light now i have dimmers and dimmers also really help because i just dim them so low um that you know at night it's like all the all the you know any light that's on our house is very very very dim and um and the other thing is that well now i don't even i don't i try not to like work and get on my laptop and ants anything that gives me emotional stimulation right if i'm whether or not it's bad or like don't look at social media like i don't want to see a bad comment or like you know anything like that um that'll get me upset that'll completely throw off my my sleep but um there are there are apps that you can put on your your computers and phones that like black out some of the blue light or you can wear the orange glasses i personally find that even watching tv uh that'll stimulate me and so that you know i try i actually prefer to just chill out um you know and maybe read a book or you just kind of decompress um but but like the the avoiding blue light at night and getting the bright light exposure i think those are the two really main main things that have gotten to me you know i go to bed i'm like in bed and asleep by 9 30. yeah that is you that is exactly you you asked me the question what's the low-hanging fruit and you you just answered it that's exactly what i would recommend and that's what i do recommend um now from there people have different uh problems uh people have sleep fragmentation where they wake up a lot some people can't fall asleep some people can't stay asleep we could we could come back and do another two hours on on recommendations for each one of those things and each one's an individual so it's it's hard to say but the kind of sleep hygiene stuff that we've just talked about can go a long way in getting you started on on finding your fitness basically yeah um yeah there's other things exercise some people think the sauna which sauna is something that you and i both uh you've recently gotten uh developed a passion for yeah so you tell me um it's something i've been passionate about for many years in public speaking about um and uh you've you've dove into a little bit about um the effects of of heat stress uh in in terms of sauna use on the immune system and lung function respiratory tract infections is also very relevant now yes exactly so so vitamin d gets me excited uh talking about sleep gets me excited but nothing gets me more excited than talking about this this is really amazing stuff because i i have a feeling that it could be helpful in covet 19 it makes plausible sense let me tell you the evidence for that just sort of offhand okay so i said at the beginning that you've got to look at covet 19 as a timing issue early on in the disease we've got good evidence now from immunologists that sars kovi 1 sars kovi 2 and mers all three of those they kind of act the same way in that early on in the disease they suppress the innate immune system so there's two parts to your immune system there's the innate immune system that's sort of the garbage collector that goes around looking for stuff that shouldn't be there and eating it up what are the tools of that innate immune system fever is a big tool of that innate immune system interferon the substance called interferon there's gamma interferon beta interferon alpha interferon all of these things are the tools of that innate immune system the other part of the immune system is the adaptive immune system that's b cells t cells that's what we're using with the vaccination what i'm talking about is the innate immune system and early on this virus suppresses the body's ability to mount that response it the thing about this the innate immune system is it's very robust in children but as you get older its efficacy diminishes with time so that's why we see fevers all the time in pediatric populations they get a virus they get a fever but we're not seeing the fever so much in the adult population and certainly not as much as we would expect to see in in sars kobe 2. now that being said as the virus using various techniques proteins things that it does as it suppresses that immune system you get this low-level viral infection that goes on for days and then finally the adaptive immune system kicks in and you get this cytokine explosion that ends people up in the hospital with pneumonia so again it's a timing issue the question is in covet 19 do you want to suppress the immune system or do you want to elevate the immune system and the answer is yes because you want to do you want to enhance the immune system at the beginning so that it gets rid of the virus but notice that all the things that work late like steroids suppress the immune system so you've got to be very careful about which phase you're looking at okay so what they've done there's a couple of papers that were published in science uh about a month or two ago they could explain 14 of all of the severe cases in their cohort based on two findings one was a genetic a bunch of genetic mutations that basically left the the subjects hamstrung in terms of secreting and producing interferon so there's interferon production is a complicated system there's many genes involved with it and at many points along that pathway there were mutations that basically caused the interferon secretion levels to be nil all of those mutations were found only in the severe covalent 19 patients okay did not find any of these in the mild patients so again there is some causation there like you were talking about before with the the the snips and vitamin d the other one that made up about 10 percent was older patients that had developed antibodies to interferon so essentially their interferon levels even though they're being produced they were being inactivated all of these patients that had antibodies against stars against interferon were in the severe none in the mild to moderate group so what they determined was that and other studies have borne this out that in order to predict a mild to moderate course of the disease you had to have an adequate interferon response early on in the course and you wanted to have that to lead to a mild to moderate if you did not have a good interferon response early on that would lead to severe disease in almost all of those cases with that in mind what i started to do was look at a number of things number one looking at heat so there was a study a number of studies actually that have been produced some at the university of toronto some also in other centers as well that showed that if you take human beings and heat them up in a hot water bath 39 degrees centigrade the purpose of this is not to kill the virus the purpose of this is to enhance the immunity and what they found was that they were able to independently of of these potential mutations that fever or or temperature itself was able to cause a secretion and elevation in interferon tumor necrosis factor those sorts of things there's one study that they did where they took subjects put them in hot water baths at various degrees so 38.5 39 39.5 etc and when they took the monocytes out of their body and put them on the petri dish and exposed it at various temperatures to lps which is lipopolysaccharide which is a universal activator of the immune system that interferon levels were 10 times higher once they got up to about 39 degrees a centigrade or celsius which is around where you start to have a fever so lots of plausibility there okay so now what we did is i looked back in history and i thought well well maybe if we started to to heat up their their bodies maybe there could be some immunity think again about the fact that 80 percent of all symptomatic cova 19 patients 80 percent never need to go to the hospital why because their innate immune system does the job it takes care of the virus twenty percent end up going to the hospital if we could somehow increase that eighty percent to eighty five ninety percent that would have a huge impact on the number of people that are seeking medical attention right now in the hospitals so i decided to look back so there was the flu epidemic of 1918 in 1919 and it got to the point in the united states now remember this is before oxygen this is before randomized placebo-controlled trials this is before the discovery of penicillin even there was two sort of two thoughts about how to treat this pandemic or this epidemic of of the flu and as these soldiers were coming back from world war one and bringing the flu with them uh there was a lot of army hospitals that were treating these patients and the thought was was that it was the symptoms of the flu that was killing these patients well we knew how to treat fever by giving aspirin aspirin had just been discovered in 1899 by the german company bayer and so a lot of bare aspirin was being used to get rid of fever to get rid of symptoms and um and we knew exactly how that went in the army camps that was the one way of treating it the other way of treating it was by doing what we've just been talking about which was rest exercise right not exercise but rest sunlight fresh air and uh and uh hydrotherapy and this was the type of of pattern that was being used in a number of sanitariums in the northeast of the united states well i i stumbled across an article that was published in 1919 by dr ruble now dr rubel was the medical director at the north at the boston new england sanitarium and what he wrote was he said you know this epidemic has given us a fine opportunity to see if there is a difference in terms of our therapies you call this rational therapies and so that's exactly what he set out to do and what he did was collected the data from all of the 10 sanitariums that he knew about in the northeast of the united states and compared them to what was going on in the sanitariums or in the army hospitals at the time so what he did was basically say which one is better is it the treatment in the army hospitals with the aspirin where we're trying to kill the fever or is it in the sanitariums where we're trying to basically increase the body temperature with hot towels and and hot foot baths and things of that nature and just just a point the things that they were doing in the sanitariums there's nothing there that we couldn't do in our own homes today i mean we've got hot water we've got all of these sorts of things so he did that and what he found was a couple of things number one he found that the there's two phases there was the early phase and the late phase just like we have with covet he's found the same thing with the flu and the thing that demarcated that was exactly what we have with the covet 19 and that is pneumonia so the practice in the sanitarium was if anybody came down with any kind of symptoms period there's no need to test you just immediately start hydrotherapy you immediately start sunlight you immediately start fresh air and bed rest that was that was the key for the sanitariums when they did that and this was a number of about 446 uh subjects only two percent of those subjects went on to develop pneumonia only two percent he was able to get the data from the senate from the army hospitals and in the army hospitals about 20 of the camp came down with the flu how many of those patients with the flu went on to develop pneumonia when they got aspirin and they got all of these other things 16 so eight times the number of people in these army hospitals had pneumonia now when you looked at pneumonia in both the army hospitals and the sanitariums the the mortality from there was about 40 to 50 percent in both so it didn't matter once you had pneumonia the damage had already been done and so when you look at the the infection fatality rate in the sanitariums it was about 1.1 percent whereas the infection fatality rate in the army camps was about point four percent so it was a fraction of that so obviously this is a different time this is a different practice this is a different uh disease but it's the same immune system and uh the fact the very fact that hydrotherapy and heat can cause potentially an increase of the very thing that's lacking that we're seeing early on in the cobot 19 course gives me pause that there is biological plausibility that hydrotherapy early on while you're supposed to be sitting home that way and waiting for you to get sick enough to go to the hospital may impact and change the course of the disease so that you don't have to go to the hospital the reason why i i find this particularly attractive is because there's no company that has to make hydrotherapy there's no rationing of hydrotherapy you don't have to leave your home for hydrotherapy you practicing hydrotherapy doesn't take away the ability from somebody else to do that all of those things are the same problems though that you have with ivermectin or high or hydroxyl or any other medication that might have to be produced and be distributed this is something that everybody can do and it's it's also got very very low risk so i i think and actually i'm working currently with um an institution up in northern california called weimar that is looking into this and we actually done a pilot project with students on the campus to do hydrotherapy to see if it will we're measuring tumor mark or we're measuring markers we're measuring inflammatory it's not a randomized controlled trial in any sense but we're trying to get more data to see if this is a plausible way of dealing with this and of course this would not be affected by the viral mutations or anything like that it's it's a way of teaching the immune system or revving up or enhancing the immune system to deal with a uh an infection that is suppressing the innate immune system so i've said a lot there uh but uh you know ask away see what you think that is a really phenomenal scholarly scholarly work that you that you did there roger diving um deep into history and and um i'm that is just so informative and i really enjoyed listening to to all of that research that you that you dug into fascinating i do have a few questions um for you and i hope i don't forget them all because there's quite a few that lined up um first of all with the interferon response that occurs when you elevate the core body temperature whether that's through a hot bath or a sauna or a steam or steam shower or perhaps even hot towels you were mentioning yeah how long does that interferon response increased interference response last is that something for example that's 24 hours like you can still measure or is it just very very acute or is it even known i don't know if it's known um i do know that in those sanitariums they were it's very labor intensive it's it's actually the reason why this went out of favor i mean you can imagine that uh here you have this practice of doing hydrotherapy which is very labor intensive and then you have the discovery of penicillin in 1928 you can just give a tablet so because of its labor intensity it was generally done maybe once a day and so if it lasts if it lasted 24 hours then that was probably enough the protocol that we're doing right now where we're testing it out is is maybe two or three times a week but it's it is very labor intensive we don't know how long it would last in your protocol that you're doing are you giving your students hot baths are they taking a hot bath and if so how hot how long and how much of their body is submerged under the water so this is okay so this is a very good question the protocols are based on the historical protocols that have been published and you can actually find his book it's called rational hydrotherapy it's written by john harvey kellogg it's about a thousand pages long it's a massive book i think it's in google scholar you you've got to sort of find the book but there's a number of resources that people are interested in one of the um really where this is practice and if you were to talk to me about a year ago i wouldn't have known anything about it i've researched it but the the body of information that has kept this alive are really the physiotherapists or the physical therapists we call them in the united states because of hydrotherapy helping in physical ailments muscles things of that nature and so they're the ones that have kept this uh this information for a long time and so what i'm the protocol that i'm going to tell you is based on what they have seen and what they have done and used and typically what is this is you basically have have the patient lie down on on a uh on a surface they and there's various ways of doing it but you can use towels that are wet and you can heat them up either in a microwave or on a stove but it's basically boiling hot water in with a towel and you basically sandwich that between uh other towels you place it on their back and you place it on their on their chest so they're basically being sandwiched they're the meat and the bread is two very hot towels and you also place a very cold towel on their head and on their neck and what you're trying to do there is you're trying to heat up the body as much as you possibly can and not heat up the thermostat which is in the brain which is going to sweat and try to get rid of that heat as much as possible so what you what you have here is you've got peripheral vasodilation that occurs trying to give off the heat but actually what's happening is it's picking up the heat heating up the core body temperature and you do this for about 20 minutes now those towels will not remain hot for 20 minutes so sometimes you have to recycle them and have have more ready to go so you heat them up you cover them up and if they're sweating then you know that you're doing what you need to be doing at the end of this 20 minutes of heat something we do that's kind of paradoxical and it is also the probably the most uncomfortable portion of this treatment is you then basically put a very ice cold towel and replace the hot with an ice cold towel and you do uh friction uh rub basically it's it's a it's a uh friction is the best way to explain it this is something that's come along for for a hundred years they've done this when we look at the data we try to see why they would do this we believe that this seems to work because the cold causes vasoconstriction and it locks the heat in so after you're done it's not easy for the heat to dissipate through those vasodilated vasculature but the other thing that it does is when you just like we know when you take a cold shower that vasoconstriction causes demargination of leukocytes and that causes the amount of leukocytes in solution if you will or in the in the vasculature to go through find the viral particles and report to their lymph nodes through that increased circulation and that sort of jump starts the innate immune system in finding those uh epitopes and presenting them to the antigen presenting cells after that's done the protocol is for them to lie down and to really not move for the next hour and to just completely rest and so this is what we're doing and i don't believe any of the students now this is a this is a student population so they're young i wouldn't expect these patients to need to go to the hospital and i don't believe that in any of our cohort they have they've progressed or gotten worse do you measure their temperature um is there a rectal thermometer in there somewhere yeah they're not doing rectal thermometers uh we're currently measuring we are measuring temperature we're also measuring a number of cytokines as well uh in that and uh we've just finished the preliminary aspect so we haven't had a chance to look at the data as yet but it'll be very interesting to see it's it's fascinating that you're adding the cold um shock and i don't know how much the friction plays a role but because you know in finland where saunas are ubiquitous um it's also very quite common to jump in a cold water freezing like the baltic sea or something you know a lot of people are jumping into the cold water after their saunas and they go back and forth as well um [Music] you know you know it's funny you say that we've how long has the human how long has the human race been on this planet we could debate that but it's probably been at least thousands and thousands of years and do we believe that we've only discovered uh immunity and and what works in the last hundred years i think not i i think a lot of a lot of learning has been passed down generation to generation and probably in multiple cultures and one thing that's really i found very interesting is no matter who i've talked to and i've talked to a number of people that are interested in this whether they are of asian descent whether they are of middle eastern descent whether they are from south america or as you mentioned in in nordic countries all of them seem to have this memory whether it's their grandmother that did it or whether they look back 100 years ago they all seem to do the same thing they come down with an illness a virus and they for instance in the middle east i was talking to someone from iran he said you know my grandmother when we got sick they would they would put us the hot sands they would use whatever was hot around them and they would use it to improve their their their current situation whether it was a viral infection or what have you and i just i think there may be something there i mean we maybe we've forgotten what we needed to do and what i'd like to say is this is that you know here we are in this pandemic and we don't have all the medications to treat all these patients instead of instead of saying you know what you're just going to have to wait at home and wait for you to be sick enough to go to the hospital that's kind of like turning back the clock thousands of years why don't we just turn back the clock 100 years and see what we did a hundred years ago when we didn't have these things and see if they work i i i 100 believe that we need to do randomized controlled trials to really see whether they work i want to see if they work but the question is is in the meantime while we're waiting for them to work if there's something that has biological plausibility and it has very little risk you know what's the risk of hydrotherapy well number one burning yourself you have to be very careful you don't burn yourself and number two if you've got a predilection for cardiac arrhythmias or tachycardia or atrial fibrillation it's probably not a wise thing to be exposing yourself to temperature extreme so barring that i think this has got pretty low pretty low risk and maybe may be beneficial so going so 100 agree with you and um you know there there have been quite a few studies looking at the health benefits of using the sauna there's been a lot of observational studies from a friend of mine dr lauquinan he's an md phd and um he is the the senior author on the paper that showed men i believe was men and women in that study that used the sauna two to four times two to three times a week had a 20 lower pneumonia risk and then if they did four to seven times a week it was maybe up to 40 percent lower something like that where it was dose dependent and they had corrected for a whole host of factors all types of different respiratory diseases they corrected for asthma lipid levels i mean just many different things and so um that that was something that was quite surprising to me and you know because i was so familiar with the literature on you know the benefits of using the sauna on cardiovascular health and how you know heat stress itself it is elevating your core body temperature in in a way is um it's mimicking exercise your heart rate elevates they've they've done a side-by-side head-to-head comparison on a stationary bicycle and comparing it to 20 minutes in a sauna and all the same physiological changes happen while you're exercising your blood pressure actually goes up your heart rate goes up you sweat your your your core body temperature elevates while you're in the sauna your blood pressure goes up while you're in there um your heart rate goes up you're sweating your core body temperature goes up but then when you're done with the exercise or you're done with the sauna blood pressure goes down even lower than baseline um you know your heart rate um improves and you know so so it's very comparable to cardiovascular exercise and there's many many benefits in terms of you know chronic sauna use and i think to some degree um hot baths you know and perhaps you know this hydrotherapy um i think that falls in that category where where you're elevating your core body temperature whether it's through a hot bath or these you know hot towels or if it's in a steam room or you know asana which is which is what i have um you know i i try to do it four times a week but it's it's it's it's fascinating that that could actually be helping my innate immune system um yeah and i think there's other studies that have shown effects as well like cold yep that's exactly right i mean not just on cardiovascular but also on on on immunity and also on i mean like real world cult so they've done multiple studies on these and they've shown there to be a benefit in that and so because it's because it seems as though the benefit that we get from hydrotherapy or thermal hydrotherapy however you want to call it seems to be the one part of the immune system that's crippled early on with this coronavirus there's biological plausibility again there that i think wow this piece seems to fit the only thing we're missing here is a randomized controlled trial boy somebody should do that i mean that that would be amazing yeah absolutely um do you do you take hot baths at home yeah so i i have a i have a spa outside actually believe it or not i live at about a mile up here in southern california so we just got about six to eight feet of snow i'm looking out the window right now because we've got about well it's melting right now but it's about six to eight inches of snow uh and so just the other day i we all went into the into our spa and heated that thing up to the max and uh got out and uh ran around in the snow rolled around in the snow and then we uh jumped back in and it was uh it was invigorating so i i do that every day my my wife is also a uh an internist she works at the hospital and so every day we've made it a point that when we come home from work and we go through our uh our rigmarole where we uh you know basically dish robe in the garage and put the coronavirus in this this basket and that goes into that uh we basically go directly to the spa and uh hopefully the the chlorine and the and the hot water kills the coronavirus but even more importantly hopefully if we happen to be exposed that day and we just don't know it yet that that treatment in the sauna or the spa i should say uh helps our innate immune system to find that virus and to kill that virus before it has a chance to to do its dirty work absolutely i i we're we've been i've been trying my husband he's been really big on um getting in the jacuzzi and then uh hopping into the 56 degree pool um i've have i'm having to adapt cold showers are a little easier for me um but but they're not i mean although they're colder now i was i was actually doing a lot of cold showers in the summer so i've been i've been doing that sauna and um the the summertime is is it's warmer the cold the cold shower is warmer so it's not really as cold as it should be so i'm trying i'm trying to to get into the cold a little bit more um what do you what are your thoughts on you know for example like people that are getting vaccines you've you've gotten the mrna vaccine so i got the vaccine oh probably a little over a week ago and i i didn't change what i was doing i was still doing it uh i don't think i don't think it would have an effect to be the way that the mrna is is delivered to the cells so that they can make the the protein is in these uh very small little micelles or these by lipid layers that shouldn't have an effect it shouldn't be immunogenic so i don't think it should affect the the the efficacy of the vaccine that using the sauna or yeah can you talk a little bit about just briefly i know we've been chatting a while i promise to wrap it up but mrna vaccines are a new technology that's i mean they're not a new technology they've definitely been um around for for a few years but it's new to humans having it you know you used in humans basically yeah so this if you think about mrna vaccines it's it's like an envelope with a message in it and that message is going to tell the cell what kind of proteins to make this is exactly what happens by the way when you get a viral infection when you get coronavirus or any other coronavirus or any other rna virus that comes along is that virus fuses with your cell whether it's in in the cells in your nasal mucosa or or anywhere else and it basically tells those cells to make protein to make foreign proteins and so in that sense this is no different we're just doing it in a way that doesn't cause more viruses to be made see when you get infected with a virus the virus tells the cells to make more of everything make more rna make more viral proteins so we your cell can make more virus in this sense the mrna vaccine is only telling your cell to make a portion of the protein which we want the immune system to recognize so that if it ever comes around again the immune system is ready to attack it and to prevent it from from uh invading your body so in that sense this is like a a sort of a dead and virus that we're putting in but it's not even that it's not even a virus it's just a portion of the mrna so what about mrna mrna is in the cytoplasm of the cell it's not in the nucleus of the cell and if you can imagine you know we had a professor on uh from uh from san diego dr crotty who i loved his analogy it's like a post-it note mrnas are like post-it notes they're here today maybe a few days later they're they're gone you you crumple it up and you throw it away they are not like your marriage certificate or your uh your social security card that you put away in a filing cabinet that you never take out and it's like the original that's like your dna that's like in the nucleus so that is not what an mrna is mrna is like your scratch it post-it notes that you post in your room and your hair today and gone tomorrow so there's really not a danger that this mrna is going to hang around and even if it were to hang around the purpose of the immune system is to find these cells with this foreign mrna in it because it makes proteins that are foreign and to destroy those cells that's why you get an immunogenic response when you get the the flu vaccine or or in this case the mrna vaccine you get pain at the site you get a little bit of a fever perhaps you might have some muscle aches body aches it'll feel like you actually have a viral infection because that's your interferon that's responding to it that's your adaptive immune system eventually that's responding to it so that that would explain moderna's vaccine and also pfizer's vaccine the other one that's coming out is the astrazeneca oxford one is does does very same thing except instead of using mrna in a little like a a lipid droplet like a butter droplet if you like it's using a different vector it's actually using a chimpanzee adenovirus that you're like why why would you use a chimpanzee adenovirus well it's because humans haven't seen chimpanzee adenovirus and so we don't want to have a vector used in that situation that could be recognized by the immune system and destroy the vector before the message gets into the cell in this case the message is not an mrna it's actually a dna and so the dna goes in to the nucleus in in the astrazeneca oxford uh version where it is transcribed into an mrna and then the rest is the same from there so that's basically the three types of vaccines currently available except the oxford the actual one i believe was just approved a couple of days ago in great britain so that'll be coming out there's a whole bunch of other vaccinations even sort of the conventional type where they actually have the protein and they inject that those are in process still they have not come out the reason why they're probably taking longer is because it takes a long time to make the protein and there's a lot of regulation that goes along in making the protein and that's why these vaccine companies who choose not to use mrna who choose to do the conventional way are taking a long time and that's why in the past it took a long time to make a vaccine because there's a lot of regulation that goes involved there's a lot of making sure that everything is purified what moderna and what pfizer and what astrazeneca are doing is they're moving that factory production point out of their realm and they're putting it into your body so it's your body that's now making the protein it's your body that's doing this they don't have to do that and therefore they can get a product faster and the other the other advantage with it by the way is we've talked about a little bit about these mutations or variants of the of the virus and we're worried whether or not the immune system is going to be able to attract this and actually be effective against it well the nice thing about the information the mrna is that if this mutation or if this variant is significant they can always change the information on the mrna so that it matches the variant and so the immune system can respond to that they can do that actually very very fairly quickly so these are all sort of uh interesting advances i could completely understand how people would say well i don't know this is kind of new let's see how this works that's a that's a perfectly rational response to have to see because they're you know obviously there's a lot of things that we don't know about and we're not going to know about it until we actually immunize and vaccinate a large population of people but so far it seems to be very safe and it seems to be effective in in in terms of with vaccines you know there obviously are potential side effects that may or may not happen in an individual i mean you can go on the cdc website and look at the variety of vaccines and look at the the potential side effects for a variety of vaccines that are available are those it seems at least looking at you know the list that those side effects typically are acute they're not long like a long-term thing that you're looking at you know a year from now all of a sudden appearing or is that something to worry about in general with vaccines has it ever really been documented yeah so yeah so there are there can be long-term effects that can happen generally speaking though 90 of those long-term effects usually pop up within the first month or two and so we're going to know pretty quickly whether or not there's going to be long-term effects in the post-marketing uh probably the worst case scenario that we've seen so far was a flu vaccine that was uh it was it was a regular flu vaccine was not an mrna was not a dna was just a regular flu vaccine that was administered in europe a number of years ago this is back in 2009 2010 and they did find an increased risk of of narcolepsy in patients that were vaccinated with that type of typical type of vaccine and the thought process there was is that perhaps there was an immune response that cross-reacted with the portion of the brain that produces hypocretin which is the the basis for narcolepsy and so it didn't happen in all of those patients but it was substantially increased in the general population so those are the types of things that we would be looking for it's usually an autoimmune response but i would just say at this point that right now right now what we what we're seeing in terms of covet infections and vaccinations your risk of getting a post-infective condition is probably higher in covid if you were to get infected with covid versus getting the vaccine remember you're going to make antibodies against multiple portions of the coronavirus and so your chances of getting an antibody that might be directed against something in your body is higher and when you have more epitopes like you would with a a natural infection with coven 19 than you would against a very specific portion of a very specific protein of sars cov2 which is the spike protein so uh for instance guillain-barre syndrome it's very well known that people who come down with viral infections can get this thing called guillain-barre syndrome which is an autoimmune condition where your antibodies attack your nerves and uh you can't uh sort of call it a sending paralysis where you can't walk and first then you can't breathe it's very rare but it's it's definitely known to happen after a natural infection well does it also happen after immunizations yes it can but we believe it's probably higher in a natural infection than it would be in immunization and when we're talking about a pandemic situation uh we see the way the risks and the benefits and we i i believe that the the benefits of getting the the vaccine outweigh the risks at least at this point given the information that we have i'm 100 with you and i also am excited about this new mrna technology that's being used um as you mentioned i think there i think there are actually benefits to to you know having having this technology um as well so i'm actually excited that it's it's actually a new a new technology that we're using for vaccines um our people like you know with covet 19 you read all these horror stories of you know obviously there's the risk of being hospitalized and going to the icu and needing oxygen and you know progressing into this severe case but there's a lot of people as you mentioned 80 percent of people that don't have to go to the hospital that they their immune system takes care of it they don't you know they don't have a real severe case but then you start to read about these other long-term effects that are cropping up like heart palpitations and all sorts of funny stuff um yeah so there's one study that showed that 60 percent a month out still had myocarditis or inflammation of heart tissue that's pretty scary you know what are the long-term effects that we're going to see from this pandemic because there's millions and millions that are being infected with this virus and so even if it's just one percent of the people getting something but we're seeing actually higher than that uh that could that could really change the landscape in terms of what we see out there in terms of disease and population so it's not this binary thing about they live they died it's they live but they've got in the term is long haulers of course and more and more people are becoming long haulers unfortunately we don't know how long this stuff is going to last but uh i i've seen uh i've seen uh studies one recent study that showed that one rare side effect was psychosis people actually hearing things and seeing things it's very rare but it's certainly something that's well documented and people have been completely healthy until they came down with the with the virus wow yeah i'm i'm certainly more afraid of long-term effects with getting covered 19 versus getting a mrna vaccine so uh you know is this auto antibodies like that you mentioned that is a common thing with getting any viral illness has that been um looked at or studied or linked to this long term yeah so they're they're looking at this we we saw in kids there was this kawasaki-like illness that uh that was occurring uh we just don't know if that's if that's similar to what we're seeing i i anticipate that we're going to be doing a lot more research in terms of the immunity and post immunity as we go well i am for one extremely excited about the vaccine um you know that has now been you know making its way to the population um and i've really really enjoyed this conversation roger what are what are some of the like the top five things that you're doing in your lifestyle right now to keep yourself healthy and your friends and your family and perhaps patients i'm not sure um obviously this is not medical advice yeah but what you're doing so i think probably one of the biggest things that i'm doing is making sure that i get enough sleep that's that's number one we talked about that number two is i am making sure that we're doing contrast showers so what is a contrast shower hot and then cold hot and then cold hot and then cold so five minutes hot one minute cold five minutes hot or three minutes hot one minute cold and another three minutes hot one minute cold hot as you can tolerate as cold as you can tolerate and as we get toward the winter months cold becomes even colder uh so those cold water in the pipes can really do it so i do that i'm also obviously taking supplement with vitamin d that's probably one of the most important ones i'm doing for others there's not as much data on but i'm still making sure i've got you know i get a nice big bowl of every antioxidant fruit i can possibly get elder you know blackberries strawberries raspberries pineapple uh that's what i have for breakfast i'm also taking knack and acetyl cysteine there's a study that showed that it improved symptoms in the flu virus we don't know if it helps in covet 19 but in as we talked about earlier with ace ii and the fact that there's oxidative stress you know knack is a great antioxidant it's packed with antioxidants and it recycles that uh the the glutathione peroxidase system which is helpful uh in dealing with oxidative stress so i'm taking that i'm also taking zinc but you want to make sure that you don't take too much zinc uh zinc uh 40 milligrams you don't want to take more than 40 milligrams of zinc a day that's elemental zinc otherwise you can have copper you know we see a lot of people in the hospital dying and uh it could really weigh on you you you've got to have you've got a place you've got to have your your your faith placed in something higher than just yourself and it's not just a matter of what what macromolecules you can take into your system but you've got to you've got to be grounded and and know what you're doing absolutely um thank you so much roger for this conversation for your amazing coverage of the kobat 19 pandemic on your youtube channel medcram videos has been um by far like my if i want to know about anything going on cobia 19 i go to medcram i tell everyone about it i mean it's it's just been very scientific analysis very well explained um to to people that don't have a science or medical background just phenomenal um job with this these videos on on copa19 um if people want to continue to to find out more about um what you're doing where's the best places they can find you um yeah so if they go to youtube and just type in medcram go to our channel and sort the videos by chronology they'll see the latest of what we're doing medcram.com and uh facebook and also twitter we uh we we uh tweet as well yeah great so everything is at medcram videos basically on all the platforms instagram pretty much facebook youtube and the website all right roger well thank you so much um i i again um i really appreciate everything that you've been doing and uh continue and look forward to to to more information that you put out and um i love i just enjoyed this conversation a trend a tremendous amount so thank you make sure you guys subscribe to our youtube channel that way you get notified every time we release a new video also make sure to check out dr roger schweltz channel medcram videos catch you guys soon you

Channel: FoundMyFitness

Views: 230,281

Keywords: vitamin d deficiency

Id: HxMEYtKYdZM

Length: 120min 59sec (7259 seconds)

Published: Wed Mar 03 2021

Reddit Comments

[u/philnm]

Thanks for sharing.

Have you watched it? Could you give a gist of it please?