Wednesday, March 18, 2020

Managing Your Health During SARS-CoV-2 Quarantine

Coronavirus is at the top of everyone’s mind recently.

By now, most if not all of us know what we need to do: wash our hands correctly, practice social distancing, stay home, and take measures to stay as healthy (and calm) as possible.

Below I’ve gathered some of the best resources to help you navigate the coming weeks .

Manage Your Stress And Anxiety Levels

  • Having a twice daily meditation practice is a non-negotiable for me right now. I follow the zivaONLINE method. It’s the trifecta of mindfulness, meditation, and manifestation and holy moly I’m not sure what I’d do without it!
  • Other meditation options include Headspace, Waking Up, plus are a ton of other options so just find one that works for YOU.
  • Learn breathing exercises to help calm yourself down if you do get hit with anxiety. Here are 10 breathing techniques.
  • Avoid a constant stream of news. Don’t get me wrong, staying informed is important. But having continual access to updates is not helpful and definitely stressful.

 

Supplements

It looks like Vitamin C could help reduce severity of the cytokine cascade. Here is a link to perhaps the most comprehensive paper to date detailing pharmaceutical, nuetraceutical and other interventions which may benefit the COVID19 disease.

Get Good Sleep

  • Sleeping a solid 7-9 hours is even more important than ever right now. And with probably heightened levels of anxiety and less movement you might need a little more help sleeping soundly. Here are a few things I do to lull me into deep sleep.
  • Doc Parsley’s Sleep Remedy has always been my go-to if I’m going through a difficult sleep period… so being stocked up on these pre-bed drinks is critical for me right now. They naturally trigger your body into the ‘falling asleep’ process.
  • Salt shot before bed. 1/4ish teaspoon of salt dissolved in a minimal amount of water taken right before you go to sleep. This has been a game changer! Especially if you’re eating lower carb.

 

Eat Well, Know Your Farmer

If you’re ordering more food online this is the perfect time to get to know your farmer—White Oak Pastures is one of our favorites. You can also find local CSA boxes for vegetables.

Keep Your Mind Limber

  • Play games! Cards, chess, board games. Something like the Words With Friends app works your mind and keeps you connected with friends.
  • Been meaning to brush up on your high school Spanish? Haven’t we all! This is the perfect time to learn a new language. Start doing an app like Duolingo or Rosetta Stone.
  • Memorize a poem!
  • Start a puzzle… and another puzzle… maybe another…

 

Move Your Body

  • Many yoga studios are offering online classes for a nominal fee… if you can afford it, this is a great way to support local business AND keep your body and mind sound. For example, The Grinning Yogi is live streaming classes. See if your local studio is doing the same!
  • Our friends at Basis Health and Performance are hosting a Mobility Reset in The Healthy Rebellion right now but if you missed that you can do their online training program here. Next week, they’re launching 2 additional programs- Online Bodyweight Conditioning Program and Online Home Gym Strength Training Program 
  • If you can’t afford it, there are TONS of other resources out there. Here are some. Also, just search YouTube videos for bodyweight workouts, HIIT, etc.—whatever you’re into!
  • As long as you’re practicing social distancing, you should still be getting outside to get fresh air and vitamin D. So including walks and bike rides weather permitting is a GREAT idea… just stay 6 feet from others on the trail 🙂

Keep Your Community

  • Schedule group FaceTimes or Zoom meetings with friends and family
  • Try to call at least one person each day
  • If you’re not ‘at risk’, check in on your elderly neighbors. If they need errands ran, go pick up their prescription or some more eggs and drop them on their doorstep.
  • Join an online community. As our IRL interaction has been dialing down our online community has been ratcheting WAY up. Our network The Healthy Rebellion has been an incredible resource the past few weeks. Our community-wide live chats, news sharing, question answering, etc has not only been calming, but informative. We’ve got a book club and we’re also doing COVID-19 Boredom Busting Daily Challenges that are fun and keep our mind and body working! Join us in The Healthy Rebellion

The Healthy Rebellion Radio

We’ll continue to put out new episodes updating you as we get more information about COVID-19.

Click here to subscribe. 

 



from The Paleo Diet https://ift.tt/3d9mg5i

SARS-CoV-2 | Salty Talk 001 | THRR


Welcome to Salty Talk. This is a special edition of Healthy Rebellion Radio. Each week on Salty Talk Robb will do a deep dive into current health and performance news, mixed with an occasional Salty conversation with movers and shakers in the world of research, performance, health, and longevity. This first episode is on SARS-CoV-2.
For the full the video presentation of this episode and to be a part of the conversation, join us in The Healthy Rebellion online community.
WARNING: These episodes may get “salty” with the occasional expletive.

This episode of The Healthy Rebellion Radio is sponsored by Perfect Keto. Perfect Keto makes eating keto easier. Perfect Keto provides clean low-carb bars, nut butters, and supplements, and the best keto recipes and info so you can keto with confidence. Go to http://perfectketo.com/salty40 and use code SALTY40 for buy one get one 40% off on all Perfect Keto products. 

 

Download a copy of the transcript here (PDF)

Show Notes:

https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

https://www.peakprosperity.com/video/crash-course-chapter-4-compounding-is-the-problem/

https://www.nytimes.com/2020/03/13/science/coronavirus-math-mitigation-distancing.html

https://www1.racgp.org.au/newsgp/clinical/examining-factors-that-worsen-coronavirus-severity

https://www.unc.edu/posts/2018/11/28/only-12-percent-of-american-adults-are-metabolically-healthy-carolina-study-finds/

https://www.technologynetworks.com/biopharma/news/first-report-of-human-monoclonal-antibody-that-blocks-sars-cov-2-332110

https://www.bmj.com/content/368/bmj.m406/rr-9

https://www.intmedpress.com/servefile.cfm?suid=35d8dc5e-70f4-491f-acad-e35f99be9211

https://www.ncbi.nlm.nih.gov/pubmed/32052466

Transcript:

Robb: Hey rebels, welcome back. Hope y’all are doing well. Clearly, the SARS-CoV-2 is on your mind. It’s on my mind. It’s shaken a lot of things up. Definitely changing our world. This episode, I’m going to try to dig into the way that I’m looking at this topic. I’m not a doctor. It’s been a long time since I was a scientist actually doing science work, but I’ve stayed on top of a lot of this stuff pretty closely and I guess one of the things that I’m really concerned about is that folks are not really taking this seriously and they’re just absolutely no doubt that things are being manipulated in a way for political gain, for posturing. All of that stuff is happening, but that doesn’t mean that there’s not a problem afoot.

Robb: And so the way that I’m looking at this is basically kind of three different pieces. The first piece being what’s our best estimate or understanding of what the current numbers are, and that includes the number of people infected, recovered, the number of people that have died. From this, we can get some sense of when an inflection point is going to be reached. When we’ve kind of hit a peak at least in theory and this can aid in all kinds of planning including how much food you need, travel, money, medications, and this is on both the micro level and the macro level. This is the type of stuff that everything from running your family to local states and federal governments need to think about this stuff.

Robb: In the US, it appears we are likely about as of the time of recording this and by the time that this goes up, we’re about, best estimate, it’s probably two to four weeks out from our peak. And when you overlay some of the data that we have with regards to cumulative cases, we are right in line with what Italy has experienced and we’re about 11 to 14-day lag behind Italy in the number of cases. And fortunately, so far we have lagged behind Italy in the cumulative death rate, but we know pretty clearly that within the Italian hospital systems, once they get overwhelmed, the mortality rate goes from somewhere around 0.6% to about 6%, if not higher.

Robb: I don’t know. It’s so hard. I think in an earlier podcast, I hesitate in these days where people speak so emphatically about different topics that this is the fact and stuff like that. But this seems to be pretty credible data. This seems to support data that came out of China and Singapore and those folks have a lot more experience dealing with stuff like this. They’ve dealt with SARS 1, they dealt with MERS and they were much better prepared than anybody in the west has been, and they still barely stayed on top of this stuff.

Robb: But I’m going to have a ton of links to the material that I’m talking about in the show notes, links to the graphics that I’m using for this. There’s a guy, Simon Kistemaker who is on Twitter and he has a piece, a comparison of the Coronavirus cases and deaths in Italy and the US 11-day lag. So I’ve got some links to that. But again, one of the first pieces that I think is important to just keep a little bit of a finger on the pulse is the best estimate of where the current numbers are and then some extrapolations from that as to where we will be in a day, a week, a month, a year, et cetera.

Robb: So the other things that I think are really important to consider in this whole topic are what are the things that we could do that might make things worse? And one of the things that pops up immediately in that story appears ironically to be NSAIDs, nonsteroidal anti-inflammatory drugs like ibuprofen. Although this is not a 100% across the board story. It looks like Neproxin and some other NSAIDs may actually have some antiviral effects.

Robb: So we have to kind of take things on a case by case basis. But as I’m going to dig into later, some other things like ACE inhibitors that are used for blood pressure medication, they correlate very poorly with good outcomes. And that doesn’t mean that if you or someone you know is on an ACE inhibitor, they should stop that immediately, but it’s just something to be aware of. The better information we have, we can start making better and more informed decisions, which leads into what are the things that we could do that could potentially improve our situation. This is above and beyond hygiene and social distancing. And I know that there’s a lot of controversy around this and I’ll talk about some of the maybe like personal freedom elements of this in a little bit.

Robb: But the basic story here, and I’m sure you guys are aware of this, but sometimes hearing it multiple ways, occasionally this can sink in. But in theory, what we’re trying to do right now is flatten out the rate of growth so that our hospital systems are not overwhelmed and this keeps the mortality comparatively low, both in our more effected population but also within our healthcare first responder population, which they absolutely get crushed under these circumstances. Particularly once the system starts to fail.

Robb: The stories that are coming out of Italy currently are pretty horrific. People in developed countries just have no appreciation for the type of horrors that are are occurring here. So above and beyond social distancing and basic hygiene, what are some things that we could do that might improve the outcome of having this condition, this disease. But it’s definitely time to take things more seriously. I get that this is a mixed bag of government overreach.

Robb: A good friend of mine who owns a number of restaurants, he posted a piece that was really well written and it is basically making the case, isn’t this kind of a First Amendment in encroachment here, telling people to not get together. We have in the United States a right to assembly. It’s tough and this is where if people take appropriate measures early and thoughtfully, then we don’t need the government to get involved with this stuff. If people are doing the things that largely probably should be done, assuming that all this stuff is on point and accurate and I’ve seen some absolutely insane conspiracy stuff floating around and I’ll try to remember to touch on some of that, but this stuff is absolutely politicized. It’s definitely being used as a political bludgeoning tool.

Robb: That’s true. Without a doubt, that’s true. I guess these days I’m kind of labeled a conservative. I’ve always been kind of libertarian leaning a fiscally conservative, socially liberal. In the days of George Bush too, most people thought that I was a complete left wing pinko because I felt like our military was doing some pretty significant overreach. In this day and age, I’m now a right wing conservative apparently, even though my personal politics haven’t really changed all that much, the world has changed a lot.

Robb: And so I get that this stuff is being politically charged and used in various ways that are arguably pretty nefarious. That can all be true and it can simultaneously be true that people seem largely incapable of understanding what I just said, and the fact that estimates to put the US death toll from the COVID-19 disease over a 12-month period between 500,000 and 2.2 million Americans dying over the course of a year.

Robb: Last year, 2.8 million Americans died from all causes. So you’re looking at an increased death rate that is just staggering. And again, there are a lot of people that are… I don’t want to say this. Well, I made some mistakes early on in this and I guess I’ll get to that in a minute, but I just need an aside. Italy is not a fucking developing nation. Some of the commentary that I’ve seen around why things got so bad in Italy, it’s so ignorant and so ill-informed, it just makes me embarrassed in a lot of ways.

Robb: Italy has an absolutely outstanding medical system and I don’t care where you are in the political spectrum like you can talk all about their socialized medicine scene or whatever, but they had advanced hospitals, phenomenally trained physicians. The shit works really well and if people would bother themselves to travel a little bit and talk to people and learn about these things instead of making these ignorant, ill-informed decisions, they would understand this better.

Robb: This is a developed nation with an advanced medical system that got completely fucking overwhelmed and now they’re just basically making decisions. One of the really gnarly news pieces, basically if you’re over 80-years-old, you’re on your own. They’re not even going to bother allocating resources towards you because the likelihood of your recovery is so low.

Robb: So that’s all I want to say on that. But anyway, a really critical piece to understanding this or to at least… Let’s just say I’m wrong. Let’s say I’m full of shit, but at least these are some things that one might ask oneself is, “Is this SARS-CoV-2 just the same as the flu or less problematic than the flu?” In the mistake that I made, I fucked this up in the beginning too, was that when I looked at the numbers for the last year’s influenza epidemic, it’s huge. It’s X number of million people infected, this many deaths, this much mortality. But what I was looking at was the end stage of a global pandemic in that case, influenza and it ran its course.

Robb: We are in the very beginning stages of exponential growth for this disease, at least in the westernized countries, China, Singapore, some of these other places closer to where this emanated from. And keep in mind too, this disease appears to have emerged for the first time, perhaps in late November. And so when you are comparing where this story is with regards to exponential growth versus where influenza is with regards to an exponential growth, we’re at the very beginning of this, and the best estimates put the transmissibility of the SARS-CoV-2 at 10 times the transmissibility. It’s 10 times easier to get than what influenza is.

Robb: And there’s a spectrum on this and I’m blanking on the term, but there’s basically different gradings of how nasty something is, how easy it is to catch. And like SARS 1 is like a 1.5. Influenza is like a three. Measles is like a 12th .measles is very, very easy to get. But the SARS-CoV-2 appears to be much more easily transmitted than what the influenza virus is and it also appears to have 10 times the mortality rate. And it has a mortality rate that is just like influenza higher within older populations, but it affects all populations. It’s much, much lower at the younger ranges, but if the individual is immunocompromised or has other health issues, which I’ll talk about that in a little bit, it can be bad.

Robb: So I guess if you’re skeptical about this, what I would recommend is you get in and deconstruct this information and you prove… I guess first yourself and then prove to me that it is inaccurate, two points, that this is the same story as the influenza virus and that means that we’re at the same place with regards to exponential growth as influenza, which is bullshit. That’s just simply not the case. And then also you get in and do the data crunching as to the morbidity and mortality associated with this condition relative to influenza.

Robb: If you can prove that it’s a walk in the park and this is all hype, that’s great, but just don’t listen to talk radio and make the assumption that you knew what the fuck is going on with this. I actually put some skull sweat into this because I’ve done this. I’ve put this stuff into spreadsheets and tried to deconstruct like are these people really representing the numbers properly? I’m not a statistician, but I’m also not an idiot with math.

Robb: As far as I can tell, these people are pretty on point, and this is where some of the information around like the general background mortality rate across the board for SARS-CoV-2 appears to be something on par with about a 0.6%. But again, when hospital systems start failing, when people cannot be intubated and put on ventilators, which there is a completely limited number of, then folks start dying and that death rate increases by a factor of 10.

Robb: So again, like I said, folks are looking at the end stage of the story, the influenza numbers, they’re comparing the beginning versus the end. Again, some of the numbers like in the 2017-2018 flu season that were between nine and 45 million cases of influenza, they were between 12 and 60,000 deaths.

Robb: The numbers that we are looking at for SARS-CoV-2 were just in the very beginning stages of that. And again, the numbers that we’re getting suggest that it’s far, far worse both in transmissibility but also in fatality relative to the influenza virus. And again, I made this mistake as well. It didn’t look like a big deal when things first got going, and it’s kind of funny because I kind of rail that folks don’t really understand exponentials, and here I actually made that mistake as well.

Robb: So the way that exponentials can kill is that the growth, by the time you notice the growth, it’s too late. And so a good friend of mine, Chris Martenson over at peakprosperity.com, he did this great analogy and a little bit of back of the napkin math and it’s a great visual to kind of figure out what’s going on. So if you imagine Fenway stadium, this giant baseball stadium, there are these upper bleacher nosebleed seats that are like eight stories in the air, and this thing is a huge bowl basically. So imagine that down at home plate at noon, somebody puts one drop of water at home plate in Fenway stadium and you happen to be handcuffed to the upper row seat in Fenway stadium.

Robb: Now, at 12:01 two drops of water appear on the home plate and then at 2:02 four drops of water appear. 2:03 eight drops of water, 16, et cetera, et cetera. So this is exponential growth and it’s happening every minute. You’re handcuffed to a seat in Fenway stadium and at noon, exponential growth starting with one drop begins. How long until you drown? How long do you have before you need to get out of there before you die from drowning? It’s fascinating because exponentials just really defy the human mind because they don’t really exist in nature that much. They describe the growth and decay of pandemics, which really don’t actually last that long.

Robb: It describes the process of like a bomb exploding, but it’s difficult to kind of wrap our head around. But people guess anything from days to weeks to months for this thing to fill up. But when you drown, is it 12:49? That’s when the stadium is full. That’s kind of stunning for people to recognize that, but what’s really, really important to understand, take a guess as to when the stadium is still 93% empty when they’re just maybe a couple of inches down on the infield of water? And that’s at 12:44.

Robb: So at 12:49 you drown, but at 12:44 you can barely see a shimmering of water down in the infield. This is what an exponential is and this is the way that exponentials can kill us if we don’t take them seriously. The exponential growth behind this disease, by the time we see large numbers of people, it’s going to be very difficult to get out in front of it. And honestly, within the United States, that’s probably where we are. We have a completely inadequate testing at present, so we don’t really know where to focus isolation and containment. The social distancing is hopefully going to affect some degree of change in flattening out the growth curve, but we’ll honestly see how that goes.

Robb: So there’s a great piece in New York Times coronavirus math mitigating by distance. If we act now versus later, the communicability of the SARS-CoV-2 could be used to an advantage and that is because it is so communicable that if it makes its way through a given segment of the population, you could make the case that it will kind of burn itself out. This is assuming though that folks can not get reinfected with this virus, which it’s not entirely clear whether that is true or not. And if folks can get reinfected or I guess it’ll depend on whether or not it’s like 1% or 100% of people can get reinfected and actually a lot of this stuff is kind of pointless.

Robb: But anyway, if you avert a case now, it dramatically changes the area under the curve of the number of people affected 30 days later. If you avert a case seven days from now, it barely changes the shape of that curve and the volume of that curve, the number of people involved at all. So if you’re going to do something, we really need to do it sooner as opposed to later because this is kind of like compound interest. Again, another exponential function. You want to get in early to affect the greatest change that you possibly can in this story.

Robb: So what are some things that could make the situation worse and poor health at large is kind of the big deal. And within that just age is a big factor, and this is similar to just cardiovascular disease risk. The number one risk associated with cardiovascular disease and heart attacks is just simply age unfortunately. Things like diabetes, obesity, hypertension, auto-immunity, kidney disease, respiratory disorders, they all play into this.

Robb: Heart disease, cardiovascular disease interestingly appears to be worse than respiratory ailments in general, which is really interesting when you consider that one of the primary modes of action is for this virus to affect the lungs specifically. So these are all arguably metabolic driven diseases. These are diseases of modernity, and we’ll talk about this a little bit more a bit later, but this is really the case for why we all should be as healthy as we possibly can.

Robb: NSAIDs are interesting and that some things like ibuprofen appear to potentially worsen outcomes. However, Neproxin and Indomethacin, which are also technically NSAIDs appear to have some antiviral activity and all mention some other pharmaceuticals, nutraceuticals and a really phenomenal review paper that gets into what is the current state of the art and understanding in kind of interventional therapeutics that can be used to change the course on this.

Robb: So some NSAIDs appear to potentially be beneficial, some of them potentially harmful in this story. This is where we need some good data crunching, retrospective studies, looking at who’s on what and how did the outcomes play out or potentially what type of interventions were used trying to help people and how did that affect things?

Robb: A kind of gnarly discovery is the ACE inhibitors drugs, one of the most commonly prescribed drugs, it’s used for hypertension, high blood pressure, it appears to enhance the ability for the virus to make its entry into the affected cells, particularly in the lungs. Again, it’s unclear whether or not somebody on blood pressure medications is going to be well served by just jumping off of the medications. So clearly if you or someone you know was on any of these medications, you’ve got to talk to your doctor and talk about the kind of risk reward story that exists here.

Robb: We have general trends emerging. We really don’t know fuck all at this moment and it’s going to take us time to put this together. But again, these are just kind of topics and lane lines that we can keep an eye on so that if any of this stuff speaks to you, if you have some chronic kidney disease, what are the pharmaceuticals and the medical procedures that are being enacted that maybe improve or worsen the viral outcome if and when you catch this condition.

Robb: This is a really big deal, and again, this is why it makes me kind of crazy that some folks are so blasĂ© about this. Fewer than 12% of Americans are metabolically healthy. And from what we can understand, it’s the metabolically unhealthy people that are disproportionately affected, which makes it really scary that a lot of folks, potentially much younger folks are going to be in this situation of needing really advanced medical intervention to save their life.

Robb: There is simply not that much resource to go around. There’s a limited number of beds, a limited number of ventilators. We’re already rationing things like masks and gowns for our medical professionals. So this is where taking some smart action can buy some time to get infrastructure and get the basic fucking necessities that we need to be able to manage this situation. 60% of Americans have at least two chronic conditions.

Robb: So even though China is westernizing and even though the population that was affected primarily… What’s interesting it was largely a more affluent population, but a very high smoking rate, particularly within men, and that certainly worsened the outcomes for a number of people. But in general, those folks are not as metabolically sick as most people in the United States. They just haven’t had enough time to get to that point.

Robb: So this could be really bad. What things might help? Pharmaceuticals, medical interventions, nutraceuticals, and there is a phenomenal paper that I have linked in the show notes. It was published in the Journal of Medical Virology, potential interventions for novel coronavirus in China: A systematic review. This was published on February 4th, 2020.

Robb: Some drugs like chloroquine would show some really remarkable promise as an antiviral agent. This is a common anti-malarial drug. There’s a host of antiviral drugs and protease inhibitors that have potential here, and this is where we really need to buy time so that people can look at these topics and not be overwhelmed with the critical care element because it could be that even people in later stage say like respiratory failure, Remdesivir is a drug which has been successfully used in recovering people from effectively the brink of death. They’re on a ventilator, they’re they’re crashing, they’re going down, And some of these drugs have been able to pull some folks back.

Robb: But if we are completely overwhelmed in our medical systems, we won’t have the time to look at this stuff in a critical way. If we’ll buy a little bit of time, then we will be able to look at things like these antivirals. There’s a thing called convalescent serum, which is basically pulling antibodies out or basically pulling a plasma out of individuals that have recovered and providing that to people that are either very sick, in which case you effectively need about a one-to-one situation.

Robb: You need one recovered person providing serum for one sick person to be able to make a difference there. However, this convalescent serum can be used as a prophylactic measure for our first responders and medical professionals and one person might be able to provide serum for up to 100 or 200 people. There’s a lot of infrastructure that’s necessary with convalescent serum. You need a dialysis or a pheresis type machinery and it is a nontrivial amount of infrastructure to do that, but it is an option.

Robb: Vaccines, there was just some word that Israel actually was already working on a an animal focused SARS-CoV vaccine and so they’ve been able to get the gene sequencing on this current virus and tweak what they’re up to with that. And so it’s a possibility that we may have a vaccine on the not too distant future, but at absolutely blazingly fast process on that would be six months from now and it’s more likely to be a year to 18 months.

Robb: Interestingly, substances that release nitric oxide, which Viagra is kind of interesting in that regard might be beneficial. Within this paper it talks about different… It goes into all the pharmaceuticals, but then also just basic vitamin and mineral status and how that may favorably play into the outcomes.

Robb: Now it is interesting, Chris Masterjohn has released a guide that calls into question whether or not we would want say like elevated levels, vitamin D or vitamin A. Usually these are our potent immunomodulators, but the way that this virus functions is by enhancing the immune response, which causes kind of a cytokine cascade, inflammation. And so this is where like it’s so interesting because you want an adequate immune response, but you don’t want an overactive immune response. So I’m going to be looking more into the specifics on the vitamin and mineral side of the story could beneficially or negatively affect this. But I would definitely check out that paper that we have linked in the show notes.

Robb: Some things that we can do. There’s some good opportunities here too if we are kind of quarantined at home, there’s some stuff that we can do. There’s some great opportunities to get in shape, set a strength or endurance goal. Even if you have to work out in your one bedroom apartment, there’s all kinds of people who are coming up with home-based workouts. They’re really phenomenal. Practice a language or a job skill. That is just an amazing way to both pass the time but improve yourself in this this moment of really just having massive challenge.

Robb: I’m actually starting to tinker with the guitar again. I have had forays into and out of the guitar over a 15-year period and my skills suck and although I’m working a lot right now, I have some time that I’m going to devote to that. And also make a case to reconnect with people even if it’s virtually with folks that you’ve lost touch with like that human contact, that human connection is going to be really important.

Robb: We have a couple of neighbors that are definitely older and I reached out to them via text saying, “Hey, if you need someone to go grab some food for you, I’ll do it.” And they were very grateful. They’re pretty set up for right now, but they said that they would reach out to me when they need some help and I got to say that made me feel good and I’m pretty sure it made them feel good as well.

Robb: Just a little bit at heading towards wrapping up on this initial piece. I’m sure it will be doing some future updates around this topic, but planning for next time, when we are all looking back at this and we will look back at this, we will get through it. It’s scary and gnarly right now, but most of us will get through it. Not everybody will, not everybody that we love will and that’s kind of a reality. And the Asian response to this versus the Western response, I really want people to take note of that.

Robb: Now some of the Asian response like in China, because it’s a largely totalitarian regime, they had the ability to enact really draconian interventions on people and I don’t know that 100% recommend that as a first line intervention. But they had experience with SARS, they had experience with MERS and just on a structural institutional level, they were ready for this. They were absolutely ready for it. And we are in the existential equivalent of having our underwear around our feet, a carrot stuffed up our ass and we’re supposed to be running a marathon right now.

Robb: And we’re doing the best job we can, but we are so completely ill-prepared for this compared relative to the way that folks who have gone through experiences like this. So when we look back, we need to really think about what we were doing on the planning side of this story. We can’t be reactive to this at all.

Robb: Planning for next time something like this will come around again. This very same contagion may come around again. It’s possible that within the Northern Hemisphere, this kind of dies back in the summer and then makes its way through the Southern Hemisphere and then ping pongs back here. This is where I am, in the fall. But when this comes back around, when anything like this comes back around, whenever we are faced with some sort of a crisis, poor health is a massive hazard.

Robb: I don’t want to be preachy like I’ve generally tried to put this stuff forward in a way where it’s like, “Hey, the folks that want to buy in, buy in. The folks that aren’t ready, that’s fine. It’s not fucking fine anymore. And it hasn’t honestly been fine for a long time. Our systems are strained to capacity every day as it is just dealing with the literal weight of our metabolically broken populace, and this starts at our food systems. It starts at the way that the political infrastructure subsidizes ship food.

Robb: The vegans are playing this thing up in such a remarkable way. It just boggles the mind to even speculate on that. But if you are not in the best health you can be, you are in danger. And what’s interesting is the specter of heart disease and cancer and diabetes just doesn’t seem to perk people up that much, but the specter of communicable disease does. And what I would tell you, what you can tell the people that you are trying to influence, this is coming again. Something like this is coming again and every time it does make its way through, the folks that are in poor health are generally the ones that fare the poorest.

Robb: So this is your time to act. This is your time to do something different. The more chronic degenerative disease is the reason why we created The Healthy Rebellion. The congressional budget office is projecting that by 2030, 2035 the US healthcare system is bankrupt from diabesity related issues alone. When you throw what the impact of this COVID 19 is going to be on our medical system, it’s just mind boggling and that I think I neglected to mention the people who are recovering from this condition, many of them have terrible lung damage, but what seems to be a commonality in these people is that they are metabolically broken.

Robb: They have the characteristics of metabolic syndrome after experiencing this disease. Now it’s still really early. We don’t know if that’s a permanent state or a transient state, but we know that anything that moves us towards metabolic derangement is bad, and when you overlay that with the general worsening of health that we see everywhere due to dietary and lifestyle issues, this is something that we absolutely have to get on top of.

Robb: So our goal in The Healthy Rebellion is to liberate 1 million people from the sick care system and that is just looking at the chronic disease process. We now need to be hypervigilant about this communicable disease piece. And as I said, Western healthcare systems are strained and near breaking already due to chronic degenerative disease. Pandemics are just poised to overwhelm the whole system and there’s really no arguing that fact going forward.

Robb: So I hope you guys are well. Take care of each other. We are doing everything we can over at The Healthy Rebellion to provide good information, good community support. We would love to have you there. I will be providing updates as frequently as I feel like they are a value to people, but you guys take care.



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Dear Mark: Coronavirus Questions

Mark Sisson sitting in a blue shirtOkay, so this situation is upon us. There’s no denying that all anyone can focus on is the coronavirus. There are several different names used for it, but I’ll use coronavirus and COVID-19 for today’s post. I asked across different venues for your questions and concerns about the topic. I tried to get to as many as I could.

Let’s just get into it:

Why do you think kids have not been so affected?

Good question. Many of the more serious issues with this happen in the lungs as a result of prior “co-morbidities” such as smoking, diabetes, COPD, or just having lived in an area of high air pollution for many years. Then there’s the notion that much of the damage that happens to infected people happens as a result of “cytokine storms,” an example of an immune system over-reacting to the insult. Because adults have been exposed to other strains of flu over their lives and have other antibodies for those flus, there might be a dangerous “mismatch” between what’s needed for COVID-19 and what their arsenal currently holds. Kids haven’t had the time to develop all the mismatched antibodies. All speculation.

And also, kids definitely have the potential to carry and transmit the virus even if they themselves don’t exhibit strong symptoms. One recent Chinese study found that 90% of kids with the virus were asymptomatic or showed just mild or moderate symptoms.

How safe do you think U.S. kids are?

I think kids are quite safe as long as this is reasonably curtailed.

When they say risk increases with age, they mean cellular age, not chronological right?

I hope so! That’s certainly part of it. If you are healthier and more robust in general, regardless of chronological age, you are likely to be more “robust” when under immune assault.

Tips for pregnant women and COVID-19?

Do whatever you can to avoid exposure. Full stop.

The CDC maintains a page for information regarding pregnancy and breastfeeding with COVID-19, but frankly it’s a lot of “we don’t know.” So far according to the CDC there is no known transmission from mother to baby via amniotic fluid or breastmilk. Of course, please consult your doctor immediately if you are pregnant and develop any symptoms.

Do you think that it’s overhyped or a real danger?

Both. It’s a real danger for some (mostly older infirm individuals with co-morbidities) and they should do whatever they can to avoid contracting. OTOH, the damage to the world economy is even now almost incalculable. How much of this was due to over-hype versus just poor prior planning will be the subject of debate for decades to come.

I do think once more testing rolls out, we’ll see that far more people are infected than we think, but that the fatality/severity rate drops.

Why the fear and hysteria from the media… what am I missing?

Humans are story-tellers by our nature. We have always used storytelling as the primary means of communication. Fireside tales, books, radio, TV, movies, Internet, gaming, school history classes, jokes—they are all stories. Every good story needs a villain. In this case, the media has found the consummate villain: an actual threat that hits all the right notes. In order to compete with other media outlets (and hence to sell ads) the tendency is to take a set of facts and weave them into a narrative that is both compelling and horrifying. COVID-19 allows for an infinite number of tales of woe and heroics—not to mention the ability for all sides to play politics with the other side.

Is it really as bad as the media is putting on?

IMO, no, but it’s early days and the situation is changing every hour. We will see.

According to UK researchers who created a mathematical model of transmissibility, each coronavirus case infected on average 2.6 other people in Wuhan. They also estimated that blocking over 60% of transmission would be necessary for infection-control measures to effectively control the outbreak. The outbreak is worsening in Europe, particularly in Italy as of today, but South Korea appears to have slowed its epidemic for now. This article in Science Mag credits the slowing number of new cases in South Korea to diagnostic capacity at scale, tracing contact with infected persons, and case isolation.

There’s another angle that I haven’t seen discussed much: air pollution. Wuhan is notoriously polluted, with terrible air quality and high levels of particulates in the air. The population also smokes quite heavily, particularly the men (who happen to be at greater risk). Smoking (and, I imagine, constant exposure to air particulate pollution) has been shown to increase ACE2 expression. That could very well be why it hit that area so hard.

If you catch & recover, is there a chance of future health issues as a result of having had it?

Apparently, reports are that a smallish percentage of people who contract this and recover are left with some damage to lung and or cardiac tissue. Maybe that recovers over time. Too early to opine. The same thing happened with SARS, if I recall correctly.

Can you get it more than once?

Remains to be seen. Some researchers are saying yes, that people are getting re-infected. Others are saying a person can “recover” but the virus lies dormant and reemerges. We just don’t know and won’t until long-term data is available.

Do you think fasting would have any positive effect on resisting it?

I would not undergo any dramatic fasting protocols at this time. I personally would adhere to my compressed eating window and limit intake to healthy fats, quality proteins, and organic vegetables. Fresh is great, but frozen and some (BPA-free) canned, jarred, vacuum-packed, and pantry items can provide quality Primal nutrition as well.

How does keto affect the body’s immune system?

In most cases a keto diet seems to support a healthy immune system, provided the foods you are eating are real, natural, etc. Whether that offers any specific protection against COVID-19 is impossible to say.

Do you think we should transition to workouts that aren’t at a public gym?

I would certainly limit my exposure to other peoples’ sweat and exhaled gases. I don’t plan to do any public gym workouts, and now most gyms have closed temporarily or will likely close across the country as the virus continues to spread. There are tons of things you can do in your home or your yard or even in a vacant field.

This is the perfect opportunity to get outside, get some sun (or cold), and move your body through fresh air. The fresh air will reduce the risk of transmission, as will the lack of people around you. The sun will increase nitric oxide, which showed some effectiveness at reducing the ability of a related virus—SARS—to replicate. And exercise is a great way to improve your overall health and resilience, as well as get out of the house and out of your own mind.

Best practices for fevers?

Stay hydrated (water and electrolytes; salty lime/lemon water). Stay in bed. Rest.

Avoid sugar and refined carbs. Sugar is one of the worst immune suppressors.

Do all the things your body is telling you to do.

In adults, I see no reason to reduce it until you’re getting to very serious temperatures—over 105, 106ÂşF. There’s actually very little evidence that fever in and of itself is dangerous. Rather, this study suggests that it’s whatever’s causing the fever that’s dangerous. The fever is the response. Animal studies indicate that treating fever with anti-pyretics might actually increase the risk of mortality, at least in influenza.

In fact, news stories are circulating, questioning whether it’s advised for patients to take ACE inhibitors and anti-inflammatory drugs such as ibuprofen if they’re experiencing COVID-19 symptoms. An article published on Science Alert suggests that the World Health Organization is digging into research presented in The Lancet that hypothesizes that COVID-19 patients with diabetes, cardiac diseases, or hypertension who are treated with ACE2-increasing drugs are at a higher risk for severe (and possibly fatal) infection. There’s concern among cardiology societies about these suggestions; the WHO has yet to release an official recommendation.

But, of course, if you’re running an extended fever and you suspect you might have coronavirus, get medical attention immediately and let them take it from there.

Are endurance athletes more at risk?

Probably. I say that because most endurance athletes overtrain to the point of occasional immune compromise. Now is not the time for that. Cut training back to 40% during this time.

Meat and corona?

Possibly my favorite meal.

My son is 22 and has asthma. Should I be worried?

Given the recent data, he is probably less likely to suffer severe consequences if he is infected based on his age, even though most of the severest cases involve lung and/or cardiac damage. Still, if I had asthma, I would do everything possible not to contract this. Not worth the risk.

Do you think when the sun comes out to play again this will die down?

I think it will absolutely help. Check out this thread on the UV index of the most affected areas. It really does seem like UV and weather and humidity can affect the viability of the virus and its ability to take hold, but this is all speculation.

A real problem will be the damage done to global economies. That might take a while to recover.

Good items to stock up on?

See Primal Provisioning for Staying at Home.

Would you travel during this outbreak?

Absolutely not.

Will taking vitamin D help people avoid getting sick?

This is a tricky one. Normally, I’d say yes, it can’t hurt and very well might help. But with coronavirus, that gets more complicated. One thing vitamin D may have the potential to do is increase ACE2 expression, and ACE2 is the same receptor to which coronavirus binds. It’s the “entry point,” how it gets in and starts destroying cells. Organs with high rates of ACE2 receptors, like the lungs, appear to be the most affected organs.

If vitamin D increases ACE2 in the lungs, for example, that could leave you more open to infection. I certainly would avoid “megadoses” of vitamin D. If you take it, do something like 1000 IUs max, or get it through food (salmon, sardines, pastured eggs, mushrooms) or cod liver oil.

Similar to the Spanish flu in 1918?

Maybe. It seems to show some similar patterns, but diverges in others. Basic concept of virulence seems similar and the same danger of overloading the medical system applies.

Tips on remaining calm and perspective amongst the panic?

The majority of the damage will be done and over in a few months. Accept what is, and know that you are doing the best you can with the tools you have.

Avoid stress. Stress increases ACE2 expression, dampens general immunity, and makes your time hanging out and relaxing impossible and miserable.

I read somewhere that a low-carb diet and high doses of vitamin C could reduce one’s chance of getting (seriously) sick from the virus. Is there any proof on that or reason to believe those claims are true?

Probably very little proof, but it’s not out of the realm of possibility. The single best thing you can do to shore up immunity is avoid sugars and industrial seed oils, get sleep, limit stress. One of the co-morbidities I’m seeing bandied about in serious patients are blood sugar disregulation, type 2 diabetes, and other conditions linked to poor glucose tolerance. In that case, using a low-carb diet to normalize glucose levels certainly won’t hurt. Of course, you don’t have to go low-carb to normalize glucose levels; it’s just that many people find that works for them.  

Vitamin C has promise. There were reports of Chinese doctors using IV vitamin C in patients and having success. IV vitamin C is a little difficult to arrange at home, but oral vitamin C is perfectly safe even at high doses and liposomal vitamin C seems to be even more effective than plain oral vitamin C.

Is it possible that frequent hand washing and sanitizer could actually hurt us by removing beneficial protective bacteria? I’m washing but also bathing my hands in dirt.

You have to look at this from two angles: acute and chronic.

Chronic sanitization of our environments and bodies promotes a worse immune system that’s more susceptible to illness and more likely to overreact to otherwise innocuous inputs.

Acute sanitization of our environments and bodies can protect us against dangerous microbes.

If you’re picking lettuce out of your garden, you can probably eat it without washing your hands.

If you’re in LAX (Los Angeles International Airport) opening the bathroom stall, touching the faucet, and flushing toilets, you should wash your hands.

And if there’s “something going around,” it’s a good idea to wash your hands and be a little more vigilant. Native Americans had robust immune systems and got plenty of microbial exposure and likely had incredibly impressive gut biomes and very little incidence of autoimmune diseases. But when they encountered smallpox, they died. They were vulnerable to an entirely novel infectious agent because they’d never encountered it before and it was sufficiently virulent.

Preparation we DO need to make… What are you doing???

I’m staying in my condo with Carrie. I have enough food stored for several weeks. I’m only going outside to go to the beach right outside the building, go for rides on the beach, runs, sprints, etc.

Staying calm, staying serene, and being prepared.

Also, read this thread and take it to heart.

That’s it for today, folks. If you have any follow-ups, I can try to get to them for next time. Ask away down below. Thanks for reading, and make sure to take care of yourself and your family.

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Why I Stopped Drinking Coffee

Hey guys!

I just wanted to pop in and talk about a question that I’ve received a ton of times in the past several weeks and months. It’s related to my iced coffee habit, which has changed to a Teechino habit.

This is not a sponsored post. I don’t work with the brand; I just really like their products. A reader actually told me about Teechino awhile back, and it sounded great, so I tried it and immediately loved it. That’s what I’ve been drinking in the morning. It’s an herbal, coffee-flavored tea that comes in different flavors. I order it on Amazon. You can also find it at Whole Foods.

Teechino comes in tea bags as well as grinds, similar to ground coffee. I buy the grinds and brew it just like coffee in our coffee maker, and then put it in the fridge to chill overnight. I add Nutpods and collagen, and mix it all up in a shaker bottle in the morning.

Ok, let me talk about why I’ve given up my regular morning iced coffee. You guys know I lovveee iced coffee. I still love iced coffee and still drink it on occasion, but it’s more like a special treat nowadays.

Why I gave up coffee

What initially made me stop drinking coffee was the caffeine. With having ulcerative colitis, it wasn’t helping my gut issues, so I switched to decaf. Having too much caffeine can obviously cause GI distress, but the caffeine was also kind of stressing me out. I had anxiety from it, especially on the days when I’d drink a cold brew in the morning. I would feel so amped up and overly stressed out all day long. I also noticed it affected my sleep.

Related to anxiety, I was starting to have acne breakouts from all of the caffeine in my system. Knowing what I know now about hormones and the liver, my body was probably stressed and overloaded with trying to detox the caffeine. Caffeine also can dehydrate you, so that’s another reason why my skin probably wasn’t looking its best.

I drank decaf for years and years. You might even remember my daily decaf habit. But then I developed a weird phlegm-producing cough that would not go away. I eventually learned that a lot of coffees have mold in them. Even organic coffees have mold. It has to do go with the processing and how they are stored. Mold is not an issue for most healthy people, but if you have an autoimmune disease and a chronic cough, it could be an issue for you.

I don’t want to be the “fun police” and tell you you shouldn’t drink coffee, but if you’re interested in cutting back on your consumption, here are some simple strategies:

  • Try decaf or half-caf coffee
  • Enjoy a smaller portion
  • Try Teechino or other coffee alternatives

I hope you guys found this post helpful. I know some of you guys have been curious about what I’ve been drinking, so if you have any additional questions, please let me know!

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5 Sustainable Swaps I’ve Made In My Kitchen

There are so many things you can do to “go green” at home that sometimes it feels overwhelming. I’m sharing just 5 sustainable swaps I’ve made in my kitchen — my favorite part of the house!

There are a 100+ things you can do to “go green” at home. Sometimes I feel bad for not doing them all, but we should all be striving for progress not perfection. Do the best you can to make sustainable choices dependent on your environment, time, resources, etc. For example, if you live in a high rise in NYC, having a compost bin may not be at the top of your list (unless your building has a compost system in place!), but you can use reusable cloths instead of paper towels.

That said, I know just how important it is for the wellness of our planet to reduce, reuse, and recycle. Whether that’s using clean beauty products in recyclable packing, reusing bags or using cloth bags instead of wrapping gifts, running errands on foot, or giving a tub full of too-small kids clothing to a friend as hand-me-downs, these are just a few of the ways I do my part to live a more sustainable life.

But, today, I want to talk about sustainability just in the kitchen. Here are just a handful of ways that we’ve made a few small changes that add up. Bonus: going green usually saves you money too!

5 Sustainable Swaps I’ve Made In My Kitchen

1. Cloth or Paper Snack Bags 

While using a washable container or Lunchskins bag is ideal sometimes you need something disposable or super lightweight. Instead of plastic baggies (because we all know how much plastic and trash winds up in our ocean), we use paper snack bags (like these). There are so many reusable food bag options out there, so if paper isn’t for you, there are cloth/velcro ones, silicon ones like the popular StasherBag, and of course endless glass Tupperware choices. If you’re able to cut out or minimize your plastic bag usage, that’s a huge start! (Plus it saves money!) We do use a gallon zip lock from time to time, but only when nothing else will really fit the bill.

2. Gardening (A Little) At Home

Herbs, greens, and tomatoes is all we really have good luck with – but hey, it’s better than nothing! Not only does it save us a few dollars (or more) during the summer months, but it means we are growing organic produce (and limiting pesticides/toxins) and minimizing our carbon footprint. We’re hoping to get the boys out there in the dirt this spring, and I have plans for a little herb collection on the new porch. If you don’t have your own space for a garden, community gardens are popping up in towns everywhere.

3. Composting

Gardening and composting often go hand in hand, but not necessarily. I tried a countertop compost years ago, and while I applaud anyone who does that, it was just a little too gross for me to have inside. In this house we have a big compost pile between our house and the neighbor’s house that our neighbor maintains and so generously shares with us. We don’t put every eggshell in there, but if I have a bowl’s worth of veggie scraps or a bunch of watermelon rinds, I send Mazen out to dump it. (He thinks it’s cool because it’s gross.) Another option we have here is companies who come to your house to pick up your compost. Black Bear Composting here in town is one that some of our other neighbors use.

4. Bento Lunch Boxes

Instead of using disposable containers I pack Mazen’s lunch in a bento. Not only does it keep his meals less of a mess, but it means I can avoid brown paper and plastic bags — there’s almost no need for single-use baggies because this box keeps everything neat and tidy. He picked out this one because it fits perfectly inside a cloth lunch bag, but there are some great stainless steel options available, too.

I just created a handy download with 75+ kids lunchbox ideas! Download it here!

5. Minimizing Paper Towels

We use washable cloths and napkins for cleaning counters and wiping hands, and try to save paper towels for bigger spills and messes. While I think the idea of going totally paper towel free is the best option, we’ve been using the Who Gives a Crap recycled paper towels to vote with our dollars. I will admit they aren’t quite as heavy duty as Bounty, I do think they’re a good compromise between all washable and using too many conventional paper towels. The more single-use items in your kitchen you can avoid (plastic water bottles, plastic bags, paper napkins, paper plates), the better! 

What sustainable swaps have you made in your kitchen?

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