Coronavirus Conversations - Day 29: A look at lifestyle choices and viral shedding

Hi everybody, it looks like we may be live. Let me know, who knows, there's a new platform here. I'm Dr. David Perlmutter and this is our latest update, coronavirus update. This, I think, is number 29, believe it or not. And lots we're going to talk about today. Did get some questions that were sent in, and I'm going to hopefully answer those for you or do my very best. And I'm going to turn off my phone so I don't get interrupted. And wow, we'll take it from there. Well, I want to welcome you all, and let's get started. Got to add a couple questions that were sent in, and I'll get to those first, then I'll take your questions in just a moment. What are my thoughts about supplementing with quinine in addition to fisetin? F-I-S-E-T-I-N. I think that the quinine supplementation that you may get from drinking quinine water or tonic water is probably not that meaningful of a dosage. I can't imagine at all that it would be hurtful. I don't know how you're going to get it. Generally, tonic water has a lot of sugar. And that has typically that's high fructose corn syrup, which is a fructose about 55% fructose. And we're going to talk about that in another context later this morning. So I don't know how else you might substitute quinine unless you're taking some kind of quinine supplement, for example, that some people take for leg cramps, muscle cramps, in which case you wouldn't get that quinine along with sugar. So I. I can't imagine it's going to hurt. Off the top of my head, if I were to get COVID-19, what might your protocol be for getting well? And that's an excellent question. If I was really sick, I guess I would be hoping that my doctors would do their very best. I'm sure they would. But beyond that, I would be super careful about my diet at that point. I would probably bump up certain things in my diet. I'm not recommending this to people, but what I would be doing is adding more turmeric, for example, much more DHA omega-3 source, and probably increase my sulforaphane and being just really very careful about getting enough sleep. I would be treating symptoms. I would take Medications I generally use if I would get a bad cold, I would take Vicks NyQuil. Who knew? I would be tempted to consider ivermectin, which is an anti-parasitic medication. But again, that's not been tried in humans. Let me just say that ivermectin showed some real promise in laboratory animals, but has not been tried and used in humans yet in terms of being evaluated with reference specifically to COVID-19. So having said that, I might consider that. But nonetheless, I don't think I'd probably do that. I will say that I will be interviewing the researcher who looked at all this information with respect to ivermectin probably sometime this week. She is in Melbourne, Australia, so we're going to get the time change right. They're 14 hours ahead, and then I'll get to chat with her. I'll do that on Zoom, record it, and of course post it for everyone here. Do I think a diet rich in added sugars makes us more at risk to a virus? Yes, I do. Do I believe it may have a role to play in worse outcome? Yes, we know that individuals with type 2 diabetes, for example, are much higher risk for having a bad outcome. And as we will explore later today, those individuals with something called nonalcoholic fatty liver disease, which is to some degree brought on by lifestyle choices, for example, a diet that's high in fructose, may do actually have much higher risk, as much as a 6-fold increased risk for a bad outcome in comparison to those who did not have non-alcoholic fatty liver disease. So let's jump into the news and we'll take it from there, figure out on this new platform how I can post. Let's just see. Here we go. Comment as David Perlmutter. That would be me. Okay, here we go. First, I want to talk about the idea of how we spread this virus. And the study that I just posted talks about the shedding of this virus during the infection. We know that the viral loads, the amount of virus in a person, is pretty much the same whether you are asymptomatic or symptomatic, whether you're having a cough and a fever or you feel great and you're infected. So the amount of virus in your body is, oddly enough, about the same. That's what the research shows, and therefore your ability or somebody else's ability to spread this virus is about the same as it relates to their viral load, whether they have symptoms or not. Certainly people with symptoms who are coughing and sneezing are more likely to spread the virus, but the amount of virus they contain in their bodies is probably the same. We don't know How long this virus remains in the upper respiratory system. And it's been estimated that the time from infection until you test negative is 21 days. That's an average. So, the mean duration of time, however, that individuals may shed the virus is, in this new study that I just linked to you, or just gave you the link to, was 12 days. The shortest time of viral shedding was 4 days, and the longest was 34 days. So another study showed that people can shed virus, or demonstrated, as long as 37 days from the initial time of infection. So that means somebody can become infected, feel better, you know, 14 days later, feel better, and then may still be shedding virus and therefore contagious for you. Or you may be contagious to the next person for as long as a month. That is something to consider. That's what the latest research is demonstrating, and I think it's actually very important to consider that, that, you know, stay in your home and don't let people, you know, necessarily visit you because they are now feeling better and telling you that everything's fine. I'm now going to link you guys to another And if you can't get these links to go in time for our time together right now, what you can do is just go back to Dr. Perlmutter, drperlmutter.com, the coronavirus section. All of these are posted and they're all dated and they're not just the abstracts, but they're the entire PDF of the research article if we're able to get them, which is almost always. We have our ways. Who knew? So this next one that I posted, by the way, coffee upregulates a pathway called the NRF2 pathway. I drink a coffee that's called Purity Coffee, and their website, oddly enough, is puritycoffee.com. I do so because probably one of the cleanest coffees I've ever found, obviously organic, and really roasted in such a way that it preserves a lot of the good stuff that goes on when you drink coffee. So That's where I'm getting my coffee these days. It's online. Now, this next study that I published, I think, is really, really very important, especially as it relates to our incredible number of rates and our death rate here in the United States. And this is a study of 202 consecutive patients admitted to hospital with COVID-19, and they evaluated them for something called non- Alcoholic fatty liver disease. Now, as many of you know, we've been talking about this nonalcoholic, in other words, fatty liver, fat infiltration into the liver not related to alcohol consumption. We've been talking about this for many, many years, at least 15 years, as being a manifestation of certain lifestyle choices. We see it commonly in people with type 2 diabetes. Commonly in people who have excess body weight. And a lot of new literature indicates that there may be a strong relationship between the development of this NAFLD, nonalcoholic fatty liver disease, and a diet that contains a lot of fructose, as in high fructose corn syrup, as in this very, very common sweetener that's added to soda, that's added to all kinds of things. And this is a study that looked at patients admitted to the hospital. They were evaluated for an enzyme marker that we use for nonalcoholic fatty liver disease called ALT. And this marker then, and the presence of nonalcoholic fatty liver disease, was looked at in terms of risk for having Bad progression of the underlying disease. Before I get there, let me show you— tell you about some of the things they found. Risk of having a bad outcome was threefold increased if you were a male and age over 68, rather age over 60, 4.8-fold increased risk for bad outcomes. So being a male and age over 60, that's me, doesn't necessarily bode well. I can't change my age. I can change my biological age, but not my chronological age. And I can't, for purposes of this, change my gender. Body mass index, higher body mass index, a 1.3-fold increased risk for bad outcome. But get this, nonalcoholic fatty liver disease, a 6.4-fold increased risk for bad outcome. NAFLD, nonalcoholic fatty liver disease, that is rampant in America, is significantly made worse by lifestyle choices that bring on overweight, that, that favor a diet higher in sugar, specifically fructose, like high fructose corn syrup. One of the highest sources of fructose in terms of concentration, highest percentage concentration, is agave nectar. So when you see agave nectar being advertised as being this healthy alternative to sugar, I don't believe it. This is fructose. It's got the highest concentration of fructose in comparison to almost anything else that's available. So keep that in mind next time somebody offers you agave nectar as an alternative. Patients with nonalcoholic fatty liver disease, which is a consequence of lifestyle choices, had higher risk of disease progression. So keep that in mind. In addition, In relating back to our earlier conversation, they had a longer viral shedding time. They shed this virus longer in comparison to those who did not have this nonalcoholic fatty liver disease, which is a marker of not healthy lifestyle choices. Now, the last study that we're going to get to before I jump on questions is a very, very interesting study, and I'll post it now. And again, all of these are on drperlmutter.com. This is a study that looks at the shedding of this virus in the feces of pediatric patients. We know that pediatric patients and young people in general generally do a heck of a lot better in terms of their response to being infected with this virus. We know that pediatric patients may often be asymptomatic. And, or if they have symptoms, they can be very, very mild. Nonetheless, they can be severe, but their risk of severe outcome here is certainly a lot less. So kids can have it, not have any symptoms, be in your home, and you don't know. And this study compared throat swabs to determine positivity, along with evaluation of their fecal specimens to determine how long are kids, pediatric patients, shedding virus. So in the respiratory tract, typically in pediatric patients, within 2 weeks they stop shedding virus from their throat swabs, but the viral RNA remained detectable in the stools of these patients, in some cases for as long as 4 weeks. 2 children had fecal undetectable 20 days after throat swabs showing negative, while another child lagged behind for 8 days. Let me read the conclusion. SARS-CoV-2 may exist in children's GI tracts for a longer time than in their respiratory systems. Persistent shedding of the SARS-CoV-2 in stools of infected children raises the possibility that virus might be transmitted through contaminated fomites, Particles of viruses with liquid. Massive efforts should be made at all levels to prevent the spreading of infection among children after reopening of kindergartens and schools. So that's really important, that once the schools open, kids going back to school, we've got to recognize that they can be asymptomatic, that their throat swabs can be negative, But they can still be shedding virus in their stools, and this for as long as 34 days. So I think this is a very, very powerful study in terms of its implications, in terms of how that relates to opening schools and letting kids go back to school. Alrighty, let's go to some of these questions. Do the bugs in your gut also influence fatty liver disease? Lydia Pearson, that's a very good question. The answer is yes, to the extent that we do see correlations in changes in the gut bacteria do correlate with fatty liver disease, diabetes type 2, obesity, weight gain, autoimmune conditions. So the answer is, I would say yes. What I have Oh, that went by so fast. Let me just see. If you have the flu vaccine, would you test positive for COVID-19? No. The way that you would test positive for COVID-19, there are a couple of ways. Number one, if you have it. Number two, if you're using one of the new immunoglobulin or antibody tests that test IgG and/or IgM, if you have COVID-19, you will likely test positive, but If you've had previous coronavirus, which happens to be very common, you might false positive test on that one as well. Next, I am 150 pounds, eat well, have Hashimoto's. I'll explain. I also have non-alcoholic fatty liver. I've seen through support groups that lots of hypothyroid Hashimoto's patients have this. That is a ton of people. You are correct. That's a great question. And that goes back to our earlier question about changes in the gut bacteria that reflect increased autoimmunity and inflammation. All of these things come together. Fatty liver disease, nonalcoholic, is related to higher levels of inflammation in the body. And so there has been disruption of both immunity as well as inflammation. Okay, Dee Dee Allman. I'm so tired of bad news. Who don't? How people recovering stop keeping the fear in us the quicker. I agree with that. We all stop watching the news and move on with our lives. We can get away from it here forever. We have to get immune to it. Peace. All right. Not sure what you're saying, but I would agree, Dee Dee Allman, that we've got to distance ourselves from. From all this aggressive fear-based negativity. Good to check in each day and hear what's going on from our leading authorities, but not dial into all the social media fearmongering that does what for you? It changes, it disrupts your immune system. The more you let that fear, anger stuff into your psyche, the more compromised your immune system will be. Okay. Are nasal steroids a bad or good idea at this time? Don't they lower immunity? No one has clarified that. The initial reports were that steroids would somehow be related to increased risk of bad outcome in people who had gotten steroids prior to hospitalization. I think by and large, nasal steroids may not be a good thing. We want a healthy immune response. What is our choice when people have oxygen saturation levels that are so low they could cause brain or organ damage other than to use ventilator? Basically, that's what you're going to get is the use of a ventilator. The idea of of oxygenating your blood. There's a device that will take your blood and oxygenate it. Extracorporeal membrane oxygenation is not very widely available. So, by and large, that's when a ventilator is used and why ventilator usage is lifesaving. Current data would indicate that about 30% of people will survive once they're on a ventilator. So that's, you know, once you're on a ventilator, that means that your risk for survival is lower. It's just the statistic I'm giving you. It's not good news at all, that's for sure. But let's look at the 30% who ultimately come off the ventilator and survive. That's why ventilators are so darn important. Okay, let me go through some more of these questions. What are my thoughts on favipiravir as a drug to shorten shedding duration and reduce hospitalization rate and not as a treatment for ICU cases? That's Tim Wells. So favipiravir is a Japanese antiviral medication that is used in combination generally with another antiviral And is being used aggressively. I think that the main outcomes are time for improvement of chest X-ray, but also looking at the time to shedding duration of— to reducing the shedding of virus, the time it takes for that to happen. That's currently in process. I think it's going to be— it may well prove helpful. There is another antiviral called remdesivir, that is being used, I think, widely in this country in terms of extended use and also compassionate use. And we're going to be seeing probably this week some of the outcomes in terms of how effective remdesivir is. But I think that these antivirals have promise, and I'm very hopeful that we're going to see Good things from them. Now, that'll be in addition to other things, that's for sure. Okay. Okay. Great points. Give me just a second and then we will close. What do you foresee as conditions that kids will go back to school under? That's a tough call. It's a very tough call. We need to get— and this is going to be a little bit technical— we need to have enough herd immunity. In other words, enough a percentage of our population having immunity, either because they've been infected and now recovered, or they have received a vaccine, which is of course not yet available. There's a certain threshold of herd immunity whereby the virus naturally is unable to keep up Its growth and will go away. That is the time then that we can think about reopening the schools. We can't be offering, I think, every school child a test of immunity to determine if he or she is now able to go back to school. We kind of have to make a decision, schools open or not. So, how do we get to this place of herd immunity? Well, let me be really technical right now. Stay with me on this one. There is a formula for herd immunity that allows us to determine when we can say that enough people have been infected that it's not going to propagate. The formula is the number 1 minus 1 divided by R0. Wow, was that technical. 1 minus 1 over R0. What is R0? R0 is the number of cases that one individual typically infects. So let's say one individual typically infects 2 people. 1 over 2 is a half. So 1 minus 1/2 is a half, 50%. That means if the R0 is 2, so 1 minus 1 over 2 is a half, 50%, we need to reach a threshold of 50%, at which point the virus will naturally decay because it can't latch on to the number of people that it requires anymore in our population to allow it to propagate. If that number is high, let's say one person affects, let's say, 4 people, then 1 over 4 is a quarter. 1 minus a quarter is 75%. That means 75% of the population has to be immune until we can say coast is clear. We're a long way from coast is clear right now. In my opinion, we're too anxious to open schools and allow people to interact again because we could get this so-called second wave. Having said that, we have to temper those statements with the recognition that people have to get back to work. But the good news is we're seeing a proliferation of these antibody-based testing protocols that take 15 minutes at most that will allow us to know who can then go back to— who can go back to work. All right, let me take one more question. And okay, la-dee-da. There is some information coming out saying the IV vitamin C is a cure. No, with all due respect, George McMillan, I don't think it's been shown it is a cure. But I think the data coming out shows that it may be helpful, and, um, uh, therefore, uh, it's being investigated, you know, an intravenous protocol being investigated. Okay, uh, I will be live tomorrow morning, 9:15, on The 700 Club, which is on Christian Broadcast Network. I'm also going to do some recording with them today that they will post online, again answering further questions. And, um, I will certainly be available doing more of these updates. I took a couple days off, had a lot of gardening I needed to do, a few other things to take care of. So let me say thank you to everybody for your attention, and I will talk to everybody soon. Thank you for spending time with me. Bye for now. Bye.