How To Upgrade Your Immune System To Fight Viruses And Prevent Disease with Dr. Roger Seheult

Coming up on this episode of the Doctor's Pharmacy.

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Hey, everybody, it's Dr. Mark Heiman. Welcome to the Doctor of Pharmacy and that's Pharmacy with an F, a place for conversations that matter. And if you care about COVID your immune system staying healthy and recovering fast and not getting along COVID, this is the podcast you should be listening to and sharing with all your friends and family and everybody you know on the planet because we have an extraordinary scientist doctor doctor and guest on the show today, Dr. Roger Sohal, who is currently Associate Clinical Professor at the University of California, Riverside School of Medicine and Assistant Clinical Professor at the School of Medicine, Allied Health at Loma Linda University. By the way, Loma Linda is where they have the most centenarians, one of the blue zones. And he's a quadruple board certified doctor in internal medicine, pulmonary diseases, critical care medicine and sleep medicine. And his current practice in California, where he's a critical care doctor, a pulmonologist, lung specialist, sleep doctor at Beaver Medical Group. And he has been also the co-founder of MedCram, which is an online medical education company that helps health care professionals and let people understand difficult medical topics. And why we're having Roger on is he has been in the trenches with COVID from the beginning and has learned so much about what we need to do to get healthy, to prevent COVID and to stay healthy and to treat it. And welcome, Roger.

Thank you so much, Mark. I really appreciate being on.

All right, well here, let me just sort of set this conversation up because the real problem that I've seen with COVID is a massive failure to address the elephant in the room, which is the health of the host and how it affects the outcomes. We know overwhelmingly from the data that if you're unhealthy, if you have obesity, if you're a little bit overweight, if you have a chronic disease, if you're elderly, that your risk of getting seriously ill from COVID and hospitalized and dying from it is dramatically higher, like dramatically higher than someone who's younger and healthier and has a good immune system. And yet nobody is talking about this. And my friend Dariush Mozaffarian and Tufts published a paper that showed that 63%, 63% of hospitalizations for COVID could have been prevented by healthier diets. And so that's just staggering to me when we think of why we have created a massive shutdown the economy, why we've quarantined everybody, why we're all hiding in our rooms. and had this miserable disruption in our lifestyles and our life and the economy is because of what we're eating. And that's just one factor that affects the immune system. So let's talk from the beginning, this high level, you know, we're in this pandemic, you know, most of us maybe, you know, didn't think that much about our immune systems beforehand, but now everybody's thinking about it. How do we improve our immune system? How do we stay healthy? What are the top three or four things we can do to boost our immune system and fight COVID and of course all other viruses and infections? And then we're going to get down into the link of what we can do between and now and tomorrow when you can actually implement some of these strategies of how to stay healthy.

Yeah, so thanks for having me on. You're exactly right. So the things that I think are the low hanging fruit is diet. There's no question about that diet is very important. We'll talk about that. The other thing that's really important as well, and we can talk more about this, is getting outside. And it's really a package deal. There is something very unhealthy about our lifestyle in the Western world, in a developed world, about how much time we're actually spending inside of buildings and not getting outside. And when I say it's a package deal, there's lights, there is fresh air, there is exercise when you get outside. When you're inside, there's a bunch of things you don't walk around as much. You're sitting in a chair. When you're outside, you're moving around. So let's talk about it. Lights. Let's talk about fresh air. Let's talk about exercise. We can even talk about heat and cold therapies as well. So diet, hot and cold, if you like, we can talk about saunas, we can talk about contrast showers, we can talk about spa, hydrotherapy, sunlight. These are the sorts of things that might explain the reason why the United States has 4% of the population, but 25% of the cases of COVID-19.

And deaths, right. Well, I feel really good about myself. The reason I'm wearing a jacket is I'm sitting outside. In Southern California, in the beautiful afternoon, it's sunny out. I'm going for a hike later. They had a sauna and a cold dip. I already did. I had my healthy breakfast. So I feel like I'm doing everything you're saying to help my immune system.

Now, if we can only get everybody else to do that, then I think we'd be in good shape.

So tell us about the link between inflammation and immunity because I think people are a little confusing. Well, your immune system creates inflammation, but if your immune system is not working, you can't fight the infections, but we have a cytokine storm that seems to kill people. So how can you have a weak immune system and still have a cytokine storm that kills people? It's a little confusing.

So talk about that link between inflammation and immunity. Yeah, inflammation is the way that the immune system does what it needs to do. It has a very specific purpose. It's the sign that things are happening, but you just don't want to have chronic inflammation. That's not a good thing because chronic inflammation can lead to disease and death. If you look at inflammation. There are the four words of inflammation, if you will, the four Latin words that we learn in medicine, which is dolor, which is pain, rubor, which is redness, tumor, which is swelling, and calor, which is heat. Those are the four symptomatic signs of inflammation. We all know that when you hit your finger in the door or you've got something going on in your body, you experience all four of those things. It's kind of like the damage that happens when you remodel a house. That damage is inflammation. But the body uses that inflammation to do what it needs to do. But after it's done, it really needs to go away. You don't want to have a mess or trash around after you do the remodel. You get rid of it because you're done with it. And that's the problem is that that inflammation that occurs in the immune system with the lungs can cause problems in the lungs and that can cause hypoxemia that gets people in the hospital and the rest, we kind of know exactly what happens from that point down. But inflammation is not good if it's.

There for a long time. So really, it's good in an acute setting to kill something or to get rid of an infection or to heal a broken toe, but it's the chronic latent inflammation that causes the problem. So for people listening, the reason why chronic disease and obesity are so correlated with hospitalization and death for COVID is because those are inflammatory states. Heart disease, diabetes, cancer, Alzheimer's, obviously are all inflammatory diseases. So is being overweight. Being overweight by definition is inflammatory and in the fat cells in your belly is a cytokine called IL-6, which is very high and it increases dramatically in the face of COVID and that causes this cascading disaster of inflammation and death for these people. So I want to make this podcast really practical, Roger. You've been really advocating for something that really is not happening out there in the public sector, in the communications from the media and the communications from the CDC, from the government, and even from major health centers, which is the things that we can do to bolster our defenses against any infection and against even chronic disease by looking at what are the low hanging fruit, like you said, that we can fix. So let's start with vitamin D. To me, this is a massive failure. We're talking about having vaccine mandates. I think we should have a vitamin D mandate based on the data that 80% of Americans are deficient in vitamin D or insufficient, and yet we're not even talking about how important it is for immunity and how we can actually improve vitamin D levels. So talk about vitamin D. Do we get enough from sun? Do we need to supplement? How much? what should we be doing? What does the data say about vitamin D and COVID?

Yeah, so from COVID and vitamin D standpoint, there's no question, it's not even controversial that COVID-19 is associated with vitamin D deficiency. Where the science diverges a little bit is whether or not you can prevent COVID-19 either in the acute setting or prophylactically by supplementing with vitamin D. And there's certainly data on both sides of that issue. We looked at much data, looking at the mortality with people who are going into the hospital, who are dying in the hospital, dying on the ventilator. And that's associated with very low vitamin D levels. So clearly it's practical, it's good. I even saw a video of Dr. Fauci saying that he recommends taking vitamin D supplementation. In fact, he takes it himself. So really, I think the question isn't should we do it? It's how much and when and all of that. what I would say is I personally take about 5,000 international units daily. I've had my levels checked and my levels are around 50, which is where I think my levels should be. I mean, if you look at for bone health, the levels are generally at 30, but I think for immunity, we have some data that seems to indicate that if it starts to drop below 50, that's when the risk of SARS-CoV-2 infection goes up. So the bottom line is I believe we should be supplementing with it, definitely during the wintertime, especially if you're someone at risk. And who are those people? Older people, people with darker skin, people who stay inside more often. Those are the people who are high risk for vitamin D deficiency.

And also obesity, if you're overweight because it's a fat soluble vitamin. So often people have this massive reservoirs of fat and the vitamin just disappears. And so you need a lot more. I also think that When you look at the data that I saw, if you look at the people who had low vitamin D or 70% were likely to end up in the hospital, and if your vitamin E level was adequate, you prevented admission to the hospital or ICU and death by 94 to 97%. And one study I saw was dramatic, which was a preliminary data, I think it's probably even published now, which showed that if your vitamin E level was over 50, the risk of death was zero. that's an unheard of kind of stat in medicine, but I don't know what you think about that.

Yeah, I mean, I have seen personally people in the hospital on ventilators and we checked their vitamin D levels and I'll have to say I could count on my hand, but there were some that had elevated vitamin D levels. So it's not a 100% protection, let's face it, nothing in medicine is, but it's certainly something that you could do very easily. I also want to make the point that I used to think this myself, so I don't disparage anybody for thinking about it, that I could package the sun somehow into just taking a vitamin D capsule. So don't think that... I think it would be a mistake if people thought that just by taking a vitamin D capsule, they don't have to go outside in the sun or be outside and get the other aspects of benefits of being outside and getting light, just to be clear.

And you said, don't take it in the summer, but you know, the reality is, I, you know, unless you're outside, mostly naked between 10 and 2 in the afternoon, then for 20 minutes, then you really do need to take it.

Right.

Because a lot, even in the summer, people work inside. They're not on, like, lifeguards are fine. If you're a lifeguard, fine. You don't need, but if you're, you know, a guide on a boat or something, maybe. But I think, I think you have to really be aware that even, even people who you think would have adequate levels They don't. And I see this all the time in the summer. Oh, it's the summer I'm not taking it.

I check their levels and they're super low. Yeah, it's certainly possible. I mean, especially now in American society and Western society where we only spend about 7% of our waking hours outside, which is extremely low. And I'll tell you, most of that time is on both ends of the day when vitamin D level production is going to be very low because we're not getting a lot of ultraviolet.

Exactly. So let's talk about a few other natural remedies and then we're going to get into some of the other modalities that are free. that you can use that are available to you all the time. So what are the natural remedies that are the highlights for you when you want to look at upgrading our immune system in the face of COVID and just in general?

So specifically with COVID we know that COVID is a virus that specifically attacks the ACE2 receptor. Why is that important? It's important because that's involved with oxidative stress. So when I talk about natural supplementation, natural remedies, things that you can take, it's usually in the realm of oxidative of stress. Now, that's not just for COVID-19. We also know that oxidative stress is involved with the flu and other viruses as well. So maintaining very good redox balance is important. What do I mean by that? Making sure that you're taking plenty of polyphenols, plenty of antioxidants. Basically, any fruits that end in the word berry is going to be very good. But if you're looking for actual supplements, some of the things that I think would be very, very important to take, one of which they've actually done a randomized controlled trial on, in the Middle East is black cumin seed. Mark, I don't know if you're familiar with that, but- oh yeah, I have.

A whole bottle of black cumin seed oil that I use on my food. I put it on vegetable salad dressing. It's really yummy. Yeah. I mean, so it's nigella seed. It's called nigella seed. Yeah, it's been shown to be, I mean, as effective as in COVID even.

They'Ve studied it, which is interesting. Yeah, and the study that was there about a teaspoon once daily, and actually I was able to get our hospital that I work at and take care of COVID patients. I was able to get it added on as a nutritional supplement. So patients that come into the hospital now that are admitted for COVID-19, they get a teaspoon of Nigella sativa every day on their hospital tray if they're able to swallow.

The oil. The oil.

These are the seeds actually. This study that I saw was with the seeds. Oh, just the seeds. We actually grind them up. and dietary takes care of that and they have them there on the side. So, you know, it's up to the patient to take it, but it's available.

I love that. I love that. Any other things besides black cumin seed that you'd want to be taking?

Yeah, so the other thing that was looked at was NAC, so N-acetyl cysteine. Now, I know that in the United States there's been a push by the agencies to make that a prescription medication because there was some use of it in these hangover clinics. But there's a great study from the 1990s, we've known this now for 20 or 30 years, that when NAC is taken over a winter season, 600 milligrams twice daily, it doesn't necessarily reduce the incidence of the flu virus, but it certainly reduces the severity of the flu symptoms. And again, that's related to making sure that you have plenty of antioxidants on board that you can take care of when you come down with flu symptoms or COVID-19 symptoms. So I would say through the winter season, I also recommended taking NAC 600 milligrams twice daily as well.

I mean, for what it's worth, I've been taking that for years and years, and I never gotten the flu, knock wood, but, you know, I think, you know, you're talking about a compound that is basically made from an amino acid called cysteine that is found in animal rich foods that is the precursor, the building block for a compound called glutathione in the body. Glutathione is the most powerful antioxidant that we make. It's a powerful detoxifier, powerful anti-inflammatory. involved in the redox signaling you talked about and keeping our antioxidant balance. It's like if all the oxidative stress are like hot potatoes that get passed down all the antioxidants, the final guy who catches the hot potato is glutathione. And that's where the final resting spot is. It ultimately kind of neutralizes it and allows you to then kind of actually not get damaged by the oxidative stress. So it's really important. And glutathione, I think, is a really important compound to be upgrading in your body not only through supplements like n-acetyl cysteine or NAC, but also certain vegetables like the broccoli family, collards, kale, Brussels sprouts, cabbage, kohlrabi, all that stuff, and also, you know, the garlic and onion family also helps to boost glutathione. So there's a lot of ways to actually upgrade it, but this is a very important idea. And it really bothers me that the government is trying to control something that's very safe, that has There's really no side effects. It has so many utilities in medicine and health. I mean, I learned about it as an ER doc because it was what we gave to patients who came in with liver failure from taking a Tylenol overdose. So if it's that powerful, if it's powerful enough to reverse liver failure from Tylenol overdose, I mean, there's no drug that can do that, right? And it's nasty smelling and we make patients drink it. It was almost like punishment for trying to kill yourself. It smells like rotten eggs. And it's the sulfur. It's the sulfur smell like a Salt, garlic, yeah. All right, well that's amazing. Anything besides NAC and vitamin D and curcumin seed, black cumin seed?

Well, there's some of the other ones that we don't have as much evidence for specifically for COVID-19, but we have plenty of evidence for us as just beneficial to us in general, like quercetin, zinc. These combinations are also beneficial, I believe, as well.

Yeah, so quercetin is a bioflavonoid. It comes from orange and onions and actually Himalayan Tartere Buckwheat, which I've talked about on the podcast, which is an incredible source of this. In fact, and you can get it as a flour, make pancakes with it. I love it. You can get it as capsules. But of course, it is very important, and zinc obviously helps with the immune system as well. All right, so those are the top supplements you think I would add a few, but let's move on to the next framework around exercise. and immune function. Because I think it's kind of like a Goldilocks situation. Like, not enough, your immune system doesn't work too much. And it's a little like if you're a marathon runner, you're gonna tank, right?

You're absolutely right.

Yeah.

So it's known as the hockey stick effect, which is the, you know, the small part of it is as soon as you start to do a little bit of exercise, there's definite improvements both based on, you know, depression, anxiety, but also cytokines. But then as you start to do more and more and more, you start to go up that hockey stick. And unfortunately, you start to reap some untoward consequences. How many times have you heard the story of somebody passing away and you're like, But man, he was like a marathon runner. And it's actually not too ironic. People who are marathon runners, people who are elite athletes, Olympians, we just had the Olympics, these types of people are trained very rigorously and they actually have very high inflammation issues. There's a document that we talked about on MedCram that basically the scientist from these countries looks at athletes and they have to treat these athletes very carefully to make sure that they're not sick. I mean, they wait four years to go to the Olympics. They don't want to be sick. And these athletes do get sick even more than regular people because they're under so much physical stress and emotional stress in terms of athletics. So you're absolutely right. But that being said, there is a plethora of evidence that exercise does a tremendous amount, not only for our mental health, but also for inflammation and for feeling well. I mean, it affects so many aspects and that's why I group it as to going outside of it being a package deal.

It's so good. Yeah, it's so good. Well, yeah, so exercise is great. What's the mechanism that exercise improve your immune system.

So we know, of course, that exercise is beneficial in terms of cardiovascular. How does it work in terms of our immune system? And it has to do with cortisol levels because they've measured this and people have lower cortisol levels. It has to do with something called BDNF, which is brain-derived neurotrophic factors. These things go up and it improves brain function as well. There's something in the immune system called inflammasomes. So these inflammasomes are what sort of sets things off. And what they find is that exercise modulates this. There was an amazing study that was done at McMaster University by Jennifer Heist. She was the director of the FIT Lab. And what she showed, she looked at the last six weeks of the school term, and these students that were under a lot of stress, she divided them into three groups. One was a control group. They didn't do anything different. The other one was a a moderate intensity, and the other one was a high intensity group. And she basically did this for six weeks. The exercise was 20 minutes a day. It was in one group, they got their heart rate up to about 80% of predicted. The other one, it was only like 50 to 60% of max predicted. And at the end of the six weeks, she measured multiple endpoints. She looked at depression scales, by the way, moderate exercise had the best depression scale. versus control group. But she also looked at IL-6, which you mentioned before. IL-6 is this measurement of a cytokine inflammatory measure, which is used in a very high in COVID-19. Those levels in the exercise group were lower than they were in the control group. So to say all of that, to say is that people who engaged in moderate or low impact exercise three times a week, about 20 minutes a day, had less depression than those people. In other words, they had less depression at the end of those six weeks than they had at the beginning of those six weeks, which is just phenomenal. In other words, not only was exercise able to completely eliminate the depression associated with stress, it was actually able to make them happier despite the fact that they were under stress. I think that's incredible. It's pretty amazing.

I think, you know, you talked about the inflammazone, the NLRP3 inflammazone, which is part of our innate immune system that is not antibody. and it gets activated in COVID really bad. It's not just the antibodies, it's this ancient part of our immune system that's been there forever that just creates a massive storm of inflammation that's non-specific. And I think a lot of it gets triggered through lifestyle factors, through obviously infections, and there's inhibitors of it. Like you're mentioning, there's ways to sort of inhibit it through exercise, which is accessible to all of us. I need a pair of shoes. And even if you don't have shoes, you can still exercise. I mean, I. And there's so much you can do at home with body weight stuff and just dancing in your living room to, you know, see you wonder like I like to do. Hey, everyone, it's Dr. Mark.

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The other thing that's important to think about, and you're an expert in this, is sleep and the immune system. And, you know, I think a lot of us are deprived of sleep, but probably 70% of Americans don't get enough sleep. We used to sleep nine hours, now they average seven. And I think the sleep deprivation plays a big role. And we know when we're run down and we're stressed and we're tired and we are more likely to get sick. So how, what is the mechanism of that? how does sleep regulate our immune system and how much should we be getting and what should we be doing to upgrade our sleep game?

Oh, wow. Okay.

So that's huge, huge topic. So, I know you did a whole fellowship in it. So, I'm like, yeah, I get it.

So, everyone needs to understand this and it's very important to understand and that is that there is a clock in your brain that tells you when everything needs to happen. So, the best analogy I can use is Disneyland. Okay. I had a friend that used to work at Disneyland, but he didn't work there in the day. he worked there at night. And that should tell you something. During the day, everything's open. People go on the rides, you buy snacks, you do all that at night. There's a complete, complete different activity that goes on at night that gets it ready for the next day so they can do that again. And so people need to realize that sleep is not just an off switch. Sleep allows the body to do processes during the night that allows to do what you normally do during the day. and if you don't allow the body to do what it does at night, you're not going to have a good day the next day. All of that is orchestrated, cortisol levels, melatonin levels, stress, exercise, all of those things, even eating and food, all of those are coordinated like a conductor of a very large symphony about what happens at what time in the night. And so what happens is that when you go to bed at night, when you go to sleep, when the sun sets, your body has been trained to go to bed and to go to sleep. And what happens is, is that we're staying up, we're watching TV, we're looking at videos, we're on social media. And the problem is that light, which is one of the sources that the body uses to entrain that rhythm, is going into the eyes, it's going back to the master clock and it's saying it's still day. And so what happens is the body gets confused. It still thinks it's day, so it starts to delay the circadian rhythm. and when it's time for you to go to bed, you're going to bed at 11:00, 12:00 at night. And what happens is that now all of those processes that were supposed to occur at night are now getting started at 12:00, 1:00 in the morning instead of getting started at 9:00, 10:00 at night. And what happens? You still wake up at the same time and you're not allowing those processes to go. So the number one problem, just to start off, is the number of hours of sleep you should be getting. For an adult, it should be at least seven hours of sleep. okay, most of us gets much fewer than that. So we're chronically sleep deprived. Number one. Number two is that when it's, when you start to go to bed later and later and later, one o'clock in the morning, 12 o'clock at night, you still have to get up early to go to work in the morning. So you're not getting the full hours of sleep. But it's even worse than that. Because if you decide that you want to go to bed earlier now that you've heard this talk, you say, hey, I need to get more sleep. I'm, instead of going to bed at one o'clock in the morning, I'm now going to go to bed at 10 o'clock at night. You are now trying to go to bed when your master clock has been set further back. You now need to start to move your clock back. And one of the ways of doing that, two ways of doing it, number one is stop looking at light at night so that your clock rhythm starts to come back. And number two, another way of doing that is to, when you wake up in the morning, is to expose your eyes to bright light that has the opposite effect. So light in the morning tends to advance your circadian rhythm back to where it was. But exposing your eyes to bright light at night tends to delay it back, back, back further so that you're getting to sleep later. And so that's a major, major issue is light at the wrong time.

So basically, if people listen to you, Netflix stock would just tank.

No, Netflix stock is, this is the beauty of Netflix. You can record it and watch it whenever you want.

I know, but people at the end of the day, they're not working. They want to come go home, relax, watch TV. It's like, I get it. I mean, I, it's tough because that's.

What I like to watch.

And, you know, it's interesting because I think that, that we, we have such a culture of non-stop 24 7 check emails at 11 o'clock at night, be on your phone, be on Instagram and social. And it's really messing up our biology because we are, we are light sensitive beings that respond to our environment in not just sort of psycho-emotional ways, but in physiologic ways that disturb our normal biological rhythms that lead to disease. It's not just about not sleeping well. It's about the immune system. It's about the risk for heart disease, there's for obesity, diabetes, cancer, all of it is connected to sleep. So now we understand we should be getting sleep and it's important for clean up and repair at night. It's important for immune system function. But a lot of people struggle with sleep. So what are your thoughts as a sleep doctor? Because you're also a sleep doctor in addition to being a critical care medicine doctor and a million other things. what should we be doing to upgrade our sleep? What are the top tips you give your patients?

Before we go out and just tell everybody you need to get seven hours of sleep, we've got to give them the tools that they need to be able to get the seven hours of sleep. And as I mentioned, if you go to bed at 12, 1 o'clock in the morning, you know, normally, if you go to bed at 10 or 11 o'clock at night now to get that seven hours of sleep, you're just not going to be sleepy. And so what we need to do is we need to shift that circadian rhythm, advance that circadian rhythm. So the number one thing that I would say is you need to get the right type of light at the right time of day. so that means turning down the lights after nine o'clock, making sure you're not on an e-reader reading at night. Use a very dim light and open up a regular book. If you have to put the light on, make sure it's low down. Make sure it's more in the red spectrum of light. And then in the morning time when you get up, make sure you're exposing your eyes to bright light. Get outside. Let the sun light hit your eyes. You don't have to look at the sun, but get outside and get exposed to bright light. in the morning. Now, in the wintertime, that might not be the case depending on where you live. You might not have sun. So it might be worthwhile to invest in a light box. They're known as SAD boxes or SAD boxes. SAD standing for seasonal affective disorder, which is actually not uncommon for people to have in the wintertime because they're not getting exposed to light and that can cause depression. But these boxes are about 10,000 lux. That's how we measure light. And just 20 minutes in the morning, in front of one of these light boxes about 11 to 15 inches away from it would be a good substitute to get that light into the eyes. You'll feel better at night. You'll feel like you're ready to go to bed. You'll sleep better. There's been a number of studies that have actually shown this, that this type of light exposure is better for quality of sleep and for length of sleep. So that's where I would start off. The other thing is if you're having difficulty going to bed at night, falling asleep, making sure that your bedroom doesn't have a television in it, making sure you're not reading in the bedroom, doing other things. that for sleeping and you'll notice that you'll be able to go to bed and that subconscious tie that you have to the bedroom will help you fall asleep as well.

Yeah, I mean, I have blackout shades. I have eye masks. I have earplugs. I have a special reading light that blocks out all the blue light so I can hook it to my book at night and read my, without any lights on for the blue light. There's also red light bulbs you can get at night. You can put in your bedside table. So there's a lot of hacks. A cool room also is really helpful. I think 68 degrees or less sometimes. often people sleep better. And there's now all these mattresses, covers and cooling beds. And I've tried the eight sleep, which I love, which is really fun. And it's great because if you have a couple that's one like the hot, one like the cold, you can adjust each side of the bed, which is kind of fun. So, yeah, get in the quality sleep. And the light is important because I think we're all, we have light pollution. And there's a really interesting book. I don't know if you read it years ago, I read called Lights Out. and it was a book about the science of how the light bulb has screwed up our health massively by keeping us out of our normal biological circadian rhythm. So, you know, we really are. And, you know, and then today, these kids, you know, they sleep with their phone in their bed. They don't turn it off. It's like, I mean, I said, I'll, like, text someone. I'll be in a different time zone in the middle of the night. I'm like, they're answering your text. I'm like, what are you doing? You should be sleeping and you should have the phone next to you, and it should be on, and you should be looking at All right, let's talk about some other fun kind of hacks to upgrade your immune system. And it's stuff that people don't really normally think about it. You talk about hydrotherapy. You mentioned earlier in the podcast, hot and cold therapy. Tell us about the science behind all this new kind of enthusiasm about hot and cold therapy, which I'm a huge fan of. I've been a fan for years, but, you know, I have a steam in my house, a sauna, I fill up the bathtub with cold water. I tried an ice plunge the other day, literally filling up a tub full of ice and a little water and sat in there. So tell us about how that works.

Oh, there's several mechanisms by how that works. I mean, we can talk about just some of just doing it, you know, over a long period of time and some, some of the benefits. I mean, if you look at some of the finished studies, they're incredible. I mean, all cause mortality, the cardiovascular.

Health.

Improved lipid profile, improved cognition, more awake, more alert. And some of these things are tied to just basically LDL, HDLs, but they're also tied to, as we talked about, brain-derived neurotrophic factors. It's also tied to cortisol. It's tied to epinephrine. It's not any one particular area. It's all of these areas, and they all seem to be improved when the body undergoes some sort of shock treatments. This seems to be the case if we're talking about eating. We noticed that people who fast, there's improvements there in the immunity. But when you're going from hot to cold, there's a numerous amount of things that get activated in not only the immune system, but the brain, the cardiovascular system. It's so wide-reaching. I mean, we can talk about the immune system since we're talking about that today. With COVID-19, it's well-documented that interferon and the mechanisms for creating interferon very early in the stage of the infection is crippled in COVID-19. So in other words, your body gets infected with the virus. One of the first things that it does is it secretes interferon to interfere with the mass production of these viruses in your body. Well, we know now that the proteins in the virus, some of these nucleocapsid proteins, are designed, it seems, to shut down the ability of your body to mount an immune response. A couple of papers that were published in science a year ago, which showed that people who had mutations in their either the production of interferon or had antibodies against interferon had worse outcomes in COVID-19. So one of the things that's really interesting that I found was there's been a number of studies that have, that where they took lymphocytes out of the body, out of the human body, and they expose them to a mitogen, which is something that stimulates them to produce interferon. And when they did it at certain temperatures, they noticed that once they hit about 39 degrees, which is around 102 Fahrenheit, there was a tenfold increase in the amount of interferon that was secreted by the lymphocytes. In other words, that once you hit a certain temperature, there was a, without signaling, just the temperature itself caused the cells to secrete more interferon. Imagine what we would do if we had people who had fever instead of trying to reduce the fever, we actually tried to stimulate a fever in adults who came down with COVID-19 to see if that would help in terms of getting over the infection.

Stick them all in a sauna is what you're saying, right?

This is something that they did. This is something that they did back at the turn of the century.

Yeah, it's quite powerful. You also mentioned a lot of cardiovascular benefits. I've seen studies showing an increase in heart rate variability, which is the complexity of your heart rate, which correlates with health and the robustness of your nervous system and a decreased stress response. And I think that there are countries like Mexico and Germany and others that use hyperthermia, which is where literally they heat you up to 107 degrees. They put you under anesthesia, they give you IV fluids, and then they heat you up if you're trying to fight, for example, cancer or fight the Lyme disease or viruses. and it's really effective. And when nothing else has worked, I sometimes send my patients for these treatments when they've had severe chronic infections that don't respond to normal treatments and they get better. It's really quite remarkable.

Yeah, I know of a place up in Northern California called Weimar University where they actually have a hydrotherapy group there. And they don't do it with general anesthesia, but they do have some pretty experienced hydrotherapists that will get the temperature up. pretty high and to the point where they're almost passing out and they do that.

I mean, they're heating us up to 107 degrees, which sounds crazy, but I did it. I did it because I had Lyme disease and Babesia and I just wasn't right. And I actually found it worked and my wife at the time did it as well and she had really high CMV virus, which is a particular nasty virus that we often get and when we're younger, and it takes up about a third of our immune system in terms of it's, you know, it just uses up a lot of energy to kind of keep it under control, like a herpes virus, like a cold sore. It's actually one of the herpes viruses. And when she did the treatment, her antibodies came down and her IgM, which shows an active infection, went away. It was fascinating to see the results of that. So I think there's a lot to that. So definitely hot therapy, we have hot bath, sauna, I was gonna say, Mark.

Mark, this is not, this is actually, I wanna connect the dots for your audience here. The way that I would propose that that heat is helping is by hyper-secreting interferon. And you know this as well, the way that we can actually treat today, hepatitis C is with pegylated interferon. That's exactly the same way we do it.

Exactly right. So we literally give people interferon as a treatment for chronic viral infections to cure them and activate your own immune system. But you also mentioned something when we talked earlier about an incredible set of compounds that gets produced by the body called heat shock proteins. And I'm working on a new book on longevity called Young Forever, which is a great title, I think, anyway. I hope you all like it. And what I'm learning about is this whole concept of adversity mimetics. These are things that stress your body, a little, but not too much, right? If you don't have enough oxygen for long enough, you'll die. If you don't have, if you get too hot, you'll die. If you get too cold, you'll get hypothermia, you'll die. So you want, it's like the Goldilocks phenomena, but there is an interesting phenomena that happens when we put our bodies in a state of stress or adversity for a little bit of time. So the heat is one of those and it produces these heat shock proteins. Can you explain what they are? and what they do and why they're so important and why they help us build our immune system and maybe even live longer.

Yeah, so heat shock proteins are basically proteins which help fold proteins, other proteins that are made and make sure that they have the right confirmation. When heat gets applied, sometimes these proteins can unfold and denature. And of course, the whole purpose of a protein is to have the three-dimensional structure that it has in the first place, otherwise it's not going to work. what these heat shock proteins or chaperones in a sense do is they make sure that things are folded the right way. And so what happens is when you have heat, that stimulates the body to make these heat shock proteins so that they are there to help fold the proteins in the correct way. And by doing that over and over again, you are using those pathways, I guess, in a teleological way we can think about it. And so so those are more available. And therefore, if they're more available, they probably do some other things as well that are beneficial that we get the benefit of if they're there. Right.

So, the good news is it's not just heat that's good, but it's also cold. So, if you get really hot, then you can go on the ice bath. So, that's a big phenomena now that's happening. Cold plunges, Wim Hof, people hiking Mount Everest in their shorts, you know, and it's crazy, but it's actually a thing that activates also a lot of healing responses in the body.

You know, this is a big thing I just noticed.

Before you get into it, I just want to, I thought of this. Wim Hof was on the podcast and he talked about how he was able to activate his own immune system through the techniques that he learned to regulate his temperature, which allowed them to inject an endotoxin, which normally would kill someone. Like, it's basically a toxin that comes from bacteria that is what causes you to go into septic shock. which kills you. And he was able to get literally inject this deadly compound in his body and completely be fine by regulating these pathways. It was documented by top research scientists. It was really fascinating to me. So there's a lot to this.

Yeah, I was just gonna say that's fascinating. One of the things that's just gone viral on social media here as we're talking a couple of days ago, I noticed was this Finnish girl who she's having these videos of her jumping into icy sea with icebergs, cutting holes in the ice and jumping in. I think this is something that we have a fascination with in some respects. But no, as you know, the Finns love to do this. And I would expect it to be anywhere, it'd be in Finland, where they have more saunas than they do people. It's- yeah, that's right.

Well, you said that if everybody in Finland wanted to be in the sauna at the same time, they'd have enough saunas.

It's true. It is true, actually. And what's even more fascinating is when they do the studies in Finland, the control group are people who just go into the sauna once a week. That's the control group.

It's not the cold therapy.

Yeah, it's very.

Important.

And I'll tell you this, something that gives me hope in that type of treatment is if you look in multiple cultures of the world that have started up at multiple times, they all have a very similar protocol when it comes to that. I mean, I know in the hospitals in the United States back in the 1920s and people like John Harvey Kellogg who wrote the book on hydrotherapy, literally, what their technique was is to heat them up 20 minutes and then for about a minute just give them the most cold ice water that they could and then do what they call friction mittens, basically friction rub on the area of the chest, the back. And that sort of the thought was is that that would open or close off the vasculature and allow the blood cells to circulate. Well, you go to Finland and what do they do? They go out, they come out of the sauna, and when they're in the cold, they take these leaves, these branches, and they hit themselves with it. It's the same situation, and you see this over and over again in different cultures, and you wonder, well, did they sort of all figure this out at the same time or did each one independently come up with this? It tells me that it works, and I think what happens is we're just now starting to figure out why it's working. and it's these proteins, these heat shock proteins, the cardiovascular system. What we're doing is we're using very simple means to leverage a very complicated system, which is the immune system, and it's very strong and it can do what it needs to do if it's given the right tools.

So the heat increases interferon. Do we know how cold therapy actually activates or helps immunity?

So what they believe is that obviously with the heat, you're building up your core body temperature. That's the point. And then at the end, they always, at the end, you want the cold and the of that from what I have read and what I understand is that that causes a very quick vasoconstriction on the surface of the body that locks the heat in so that when you're done with it, that heat stays in the core, keeping the core body temperature elevated. But then when you have a vasoconstriction of the peripheral vasculature, the white blood cells which have adhered to the wall of that vasculature get knocked off, they get demargination. and they're able to go into circulation and go through the lymph nodes and do whatever the immune system has it do, presenting antigens and things of that nature. So that's kind of the rationale for why we always end on a cold as opposed to starting on cold.

So basically, once you get in the ice bath, you don't want to get back in the sauna.

Correct.

Yeah.

So you usually end on the cold.

Oh, geez. Okay. Well, that's the thing. I do that. I do that. And sometimes I go overboard and I stay in too long and I'm like, shaking and, you know, really cold. All right, well, this is great. So we've got, we've got, we've got basically vitamin D. We've got sleep, we've got exercise, we've got hot and cold therapy. Next is really the, the, the obvious, which is food, because food also is a huge regulator of immunity. And, and what's really happened in covet is that we've revealed the underbelly of our American diet, which is an inflammatory diet. and basically what happens is that Americans are eating total crap, most of us, 60% of our diet is processed food, 67% of kids diet, 88% of us are metabolically unhealthy, which means that we're all pre-inflamed, we're all pre-inflamed because of the food we're eating. So what are the foods we should not be eating to strengthen our immune system and then what should we eat to actually upgrade our immunity?

All right, so here's the lowdown, eat less food, more plants. That's basically it. And why do I say that? I say that because of inflammation. So we talked about antibodies and chronic inflammation not being good. There's some new research that's coming out of it's been around for a while, but we're starting to connect the dots a little bit better about what it is about red meat specifically that is so inflammatory. And one of those things is the sialic acid. Sialic acids are like the little finger tentacles on the surface of the cells they come from non-human animals, actually in humans as well. And sialic acids is what tells the immune system what is self and what is non-self. And the bottom line is, is that when you, when a human being eats animals, there are non-human sialic acids that get digested, they get absorbed whole, they get put onto our cells because our enzymes can't tell the difference between them. And so now what happens is we start to have on the surface of our cells, sialic acids that we didn't normally have and our immune system doesn't recognize them and we start to get inflammation. And there was a great study that was done in France that looked at animal products. They looked at specifically red meat because there are no sialic acids like this in chicken, in fish, or in eggs, but it's only in milk and red meat and they were able to show pretty effectively that people who had more of these sialic acids in their diets had higher antibodies against these sialic acids in their blood. And that sort of connected the two dots of a dietary composed of higher sialic acids also correlated to higher antibodies against sialic acids.

Well, that's fascinating around the meat question because this means good or bad, and we've had many podcasts on this. And I think that it, like anything, it depends on what, right? So the quality matters. And I, you know, there's some interesting preliminary data on the different quality of meat depending on feedlot cow versus, for example, a wild animal or a regeneratively raised cow. The regeneratively raised cow are full of phytochemicals and antioxidants and may not have the same effect. the only study that there's more coming down the road, but the only study I saw was really compelling was in Australia that you can buy kangaroo meat in the grocery store. And it's wild, it's wild basically kangaroo meat. And they compared that and its effect on your biology to eating feedlot meat. And they found that the feedlot meat actually increased inflammation, whereas the kangaroo meat decreased inflammatory biomarkers in the people. So when you say meat, it's like saying you know, vegetables? Is it, is it a vegetable that's, you know, like a tomato that's grown in crappy soil and shipped for miles and stored for a year and has no nutritional value? Or is it like a ripe, August cherry tomato that you grew in your organic garden at the end of the summer? So, like, they're very different in terms of quality. So I think that's important. What else should we be not eating?

And what's the other big immune screwer-upper? That's a good one. Screw-upper. So I think, again, if we derive most of our protein from plants, we're going to be better off. We talked about the polyphenols, we talked about some of these compounds that are in plants that are beneficial, some of these oils actually. We could talk about even essential oils, which we are using even today that I recommend to my patients who are having issues with olfaction after, in other words, being able to smell after COVID-19. There's some very good randomized controlled trial data that shows that that essential oils in that type of a factor work very well. And so those very same oils are in dietary aspects of our food that are grown from plants. So I think those are the major issues there. I would just mention, Lachian to what you said, the antibiotics used in this country, we think about antibiotics used and how increased antibiotics can cause resistance. I was blown away to learn that the majority of the antibiotics that are dispensed and used in the United States and many developed countries are not in humans. They're in to raise animals. No, no, no.

It's like 29, 37 million pounds of antibiotics. 29 million are used for prevention of disease in animals. Not even for treatment of disease. It's terrible. I mean, you're leaving out to me what is the biggest driver of suppressed immunity in our diet, which is the massive load of sugar and starch. in our diet.

Yeah.

Can you talk about that?

Well, yeah. So sugar is, sugar is not just sugar, right? So there's that, just like you mentioned, there's different types. There is complex carbohydrates and there are simple carbohydrates. And when you look at complex carbohydrates, things that you get, the sugars that you get from fruits, vegetables that are complex with fiber and that give slow release when you digest is completely different. than the types of sugar that you get when you buy processed foods in the store and you go get 12 dozen donuts. So these are very different. When you get a massive increase in blood glucose when you eat a donut, that's going to have a very different effect on insulin secretion than when you eat, let's say, you know, an apple, not juiced, which is slowly released, complex carbohydrates. These are complex sugars that have to be broken down. as opposed to drinking, you know, juice.

Yeah, I think, I think you're right. I think, I think your idea is really important. You want to get your sugars from Whole Foods, your starch from Whole Foods. There's a lot of scientific shift from redefining complex and simple because a vegetable is a complex carbohydrate, but so is white bread, right? So, so white bread actually is a higher glycemic index than white sugar. So we should be talking more about the glycemic load of the food as a better marker for what we should be eating because we want more vegetables. which are complex carbohydrates, but we don't want more bread, which is also a complex carbohydrate. So that's really important. I would also push back a little bit on the meat thing because, you know, we talked earlier about the importance of NAC and N-acetyl cysteine. But most plant proteins are extremely deficient in cysteine. So unless you're actually taking a supplement or you're eating, you know, cysteine rich foods, you're not going to be getting the level of cysteine to build your.

Own levels of glutathione.

What do you think about that?

Well, the only, the flip side of that, of course, is that if you have too much cysteine and that more than you need, you've got to get rid of that sulfur. And that sulfur has a negative two charge. It's got to go through the kidney. So you're excreting a lot of sulfates. And the only way that that can get excreted is if it's complex with calcium. So there's been actually some studies that have looked at proteins. They've, I've seen some animal studies where they've fed animals high amounts of, of animal protein versus plant protein. And the, the, there, I could see it. I mean, their, their legs were actually bowed because of the calcium leached out of the cell. So it's a double-edged sword.

Yeah, that's right. I mean, animal protein does create an acid load, which is a thing that you have to manage. But if you eat a very alkaline diet, which is primarily plants, then you're going to increase your alkalization and your pH will go up, which will prevent the acidification that causes bone loss. So I think it's like, how do you thread the needle? And you can check your urine pH and see what's going on. you know, I have people actually often you can take potassium citrate, which is an alkalizing substance that helps mitigate a lot of the factors.

So it's a very nuanced conversation. And Mark, I have to confess that I'm a little bit biased coming from Loma Linda. I mean, you know about the Adventist Health Study, Blue Zones.

Yeah, of course, of course. We have centenarians for a good reason. Well, this is true, but I would push back again because I think, you know, we often ascribe meaning to things that may have other explanations, right? So Loma Linda, yes, they have a very tight religious vegetarian Community. They are very Network. They don't smoke, they don't have bad habits. They exercise, they take care of themselves. It's not just a vegetarian diet. And, and you've got the, you know, the largest population in history, you know, was, was the centenarians that were in the Plains Indians who only ate Buffalo. Right. Or you go to, you know, and I think, you know, there's some, I was in Sardinia this summer, and the majority of their diet is cheese and, and, and, and, and, and sheep and goat. And then they, of course, they eat plants, a lot of plants, but, but they do eat a lot of that. And I think, and they have the longest of males in the entire world. So there's, there's a real nuance of, like, the quality matters, the sourcing matters, what are the animals eating matters, where does the milk come from? I mean, there's certain phytochemicals in milk like catechins that you get from goat milk that are as high as you can get from green tea, which is a plant compound. So we're, we're just, this whole field is so morphing and emerging.

And, and I think the question is how do we start to measure these effects in our biology in real time? Yeah, I was just going to say the Adventist Health Study two, which was done in Southern California, primarily included Loma Linda. It's actually interesting because the majority of those people that took part in that trial actually were not vegetarian. They were people who ate meat. And so they were able to show, so here's a homogeneous population. They do all of those things, you know, tightly religious, all of those things. But the only difference between them was what they ate. And they were able to see a pretty, pretty consistent stepwise function between those that had omnivores versus vegetarian vegan. And, and the stepwise function also correlated to diabetes risk, BMI, So, yeah, it's.

In the nutrition science is the hardest thing to do because the best thing to do would be to lock people in a room for 50 years and control their diets and then see what diseases they got. And that ain't happening.

So I think we might be pulled into the Hague if we did that.

I mean, you know, it's a little, yeah, scary, but, you know, this is just such a great conversation about really empowering things people can do to take control of their health in the face of COVID and other threats to our immune system and chronic disease is also, I think, very much affected by this. So I'm just so thrilled that you're thinking about this. You're, you know, a quadruple board certified straight up doc, and you looked at the literature and you've come to the conclusion that there's a lot of stuff we're missing and leaving on the table when it comes to recommendations around how we can bolster our health in general, particularly around COVID and our immunity. Obviously, you mentioned sleep, you mentioned exercise. diet, as well as certain supplements like vitamin D and acetyl cysteine, black cumin seed extract. This has been such a great conversation. All the stuff is going to be in the show notes. And I encourage people to check out Roger's work. Go to medfram.com you can listen to a lot of his talk and explanations about very complex medical issues. Do a great job of explaining everything. And I'm just so happy to have you as a guest on the doctor's Pharmacy.

Thank you so much, Marcus. It's a pleasure to be and everybody.

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