Rhonda Patrick COVID-19 Q&A

Watch and read from at Foundmyfitness.com

Key Takeaways

  • COVID-19 targets the ACE2 receptor to gain entry into cells
  • COVID-19 viruses then inject their RNA into the cytoplasm of the cell to create RNA dependent RNA polymerase (a key ingredient in replication)
  • Counter-intuitively: Having fewer ACE2 receptors for the virus to bind to is actually a bigger problem and an effect of the virus spreading (at least as seen with SARS-COV1) – People who have decreased ACE2:
  • Vitamin D: Most people are deficient in Vitamin D which could play a key protective role in acute lung inujry and ARDS by regulating the Renin-Angiotensin System)
    • Most people lack enough vitamin D, in particular the Elderly, Obese and African Americans
  • No mothers do not pass COVID-19 to baby’s in utero
  • Do date we do not have any well controlled, sizable Randomized Clinical Trials to prove Hydroxychloroquine’s effect (they are underway now)
    • Hydroxychloroquine has been shown to be a Zinc Ionaphore which could block RNA polymerase which is required for the virus to replicate
    • Quercitin may help in a similar way
  • No direct data to support IV Vitmain C, Sauna or Melatonin for COVID-19, but some reasons to believe exist

How Does COVID-19 Work

  • COVID-19 targets the ACE2 receptor to gain entry into cells
  • COVID-19 viruses then inject their RNA into the cytoplasm of the cell to create RNA dependent RNA polymerase (a key ingredient in replication)
  • As more virus bind to ACE2 the can be sequestered from the cell surface which may lead to a loss of ACE2 function
  • Loss of ACE2 can lead to a reduction in ACE2 which can lead to serious lung problems (and was seen with SARS-COV1)
  • Counter-intuitively: Having less ACE2 receptors for the virus to bind to is actually a bigger problem and an effect of the virus spreading (at least as seen with SARS-COV1) – People who have decreased ACE2:
    • Those with Chronic diseases
    • Decreases with age
    • Males (ACE2 gene is on the X chromosome, women have 2 of them)
  • Recombinant, soluble ACE2 in the blood could actually help, as it could bind/sequester virus (to be tested in clinical trials)

Are Children/Infants Susceptible to COVID-19?

  • In general, children are much less affected
  • Children represent 1-5% of known cases
  • Most children have mild or no symptoms, few may progress to lower respiratory infections
  • However, young children/infants are more susceptible to infection, 5% had low O2 levels and 0.6% progressed to ARDS (Acute Respiratory Distress Syndrome) – study of over 2,000 Chinese children
    • These ares are far better than adults
  • Children with respiratory problems or are compromised are at higher risk

Why are Children Less Severely Affected

  • COVID-19 targets ACE2 receptor to gain entry into cells, and the maturity/structure/quantity of the ACE2 system is different in children
  • Children often experience respiratory infections like RSV and may have higher levels of antiviral antibodies vs. Adults

Are Kids Spreading the Virus?

  • Probably, yes

Fecal-Oral Transmission?

  • Small Study: 8/10 children were found to have virus in a fecal testing after testing negative
  • Not enough evidence to confirm this

Can COVID-19 be passed from Mother to Child When Pregnant?

  • No mothers do not pass COVID-19 to baby’s in utero, in contrast to other viruses (data from 3 studies of 51 pregnant mothers)
  • However, it does appear that Antibodies for COVID-19 can successfully transfer to the baby (study of 6 mothers)
  • CDC recommends mothers to breast feed (breast milk does not appear to transfer the virus), but to wash hands and use a face mask while feeding

What About Hydroxychloroquine as a COVID-19 Treatment?

  • This is an old, generic and well known medicine, often used for Malaria, RA and Lupus with a pretty good tolerability profile
  • Major side effects include QTC Prolongation (the time between heartbeats which can lead to death), loss of vision (with chronic use), heart arrhythmia
  • DO NOT TAKE AT HOME WITHOUT A DOCTOR’S GUIDANCE
  • Do date we do not have any well controlled, sizable Randomized Clinical Trials to prove Hydroxychloroquine’s effect. What (not great quality) data we have:
    • Open Label Non-Randomized Trial: 32 patients treated for 6 days, some also got Azithromyacin (antibiotic with anti-viral properties) –> 70% of patients treated vs. 12.5% had cleared the virus (100% of patients given both drugs cleared the virus)
    • 80 Patient Observational Study of Hydroxy/Azithromyacin combo: 78 patients improved
    • Small Chinese Study in Mild/Moderate Patients showed no improvement
    • Small 11 patient study found no benefit of the combo in severe patients
  • Large Controlled Studies Are Underway in the US/China

How Might Hydroxychloroquine Work?

  • COVID-19 viruses bind to ACE2 receptors and inject their RNA into the cytoplasm of the cell to create RNA dependent RNA polymerase (a key ingredient in replication)
  • Zinc: Inhibits RNA dependent RNA polymerase stopping replication of virus
    • However, as a + charged ion, it can’t get inside of cell without a transporter (ionaphore)
  • Hydroxychloroquine has been shown to be a Zinc Ionaphore in a cancer model
  • It is also an antioxidant and MAY play a rolling in reducing the risk of “cytokine storm” – where your immune system gets to aggressive in critical patients that it often kills (not the virus itself)
  • Hydroxychloroquine has some data to imply its more effective against COVID-19 than Chloroquine (a more toxic/older version of the drug)

Can You Talk About Quercetin’s Role as a Zinc Ionophore?

  • Quercitin is a Flavinoid found in: Onions, green tea, berries, ginko, etc.
  • Lab data has shown it blocks SARS-COV-1 (not 19) from entering cells (zinc ionophore activity)
  • Very low risk, available as a supplement
  • 1 Canada/Chinese trial underway – reading out in August
  • Quercetin has be ID’d as one of many existing drugs that might be re-purposed to treat COVID-19

Is There Any Indication Blood Type Influences COVID-19 Risk?

  • Minimal data available
  • Type A may have a higher risk:
    • Background: Type A means you have antigens to Type B blood (but not O)
  • Type O may be lower risk (can’t receive blood from Type A or B)
    • These Type A antibodies might be helpful against COVID-19 by inhibiting the interaction with the ACE-2 receptor used by the virus to enter the cell (was seen with SARS-COV2)

Does Vitamin D Upregulate ACE2 Receptors and Its Impact on Risk for COVID-19 infection?

  • It is NOT just a vitamin, it is a Steroid Hormone that regulated up to 5% of the human genome
  • Vitamin D is essential to human and immune system help (more NOTES HERE)
  • Vitamin D3 is a fat soluble hormone created upon the exposure of the skin to sunlight (UVB)
  • ~70% of Americans have insufficient (<30 milligrams per nanomoter) Vitamin D and 28% have Deficient levels (<20 milligrams per nanometer) (NHANES)
  • The Elderly: 63% more likely to be deficient and 43% more likely to be insufficient, their ability to make Vitamin D from the sun is reduced (a 70 year old makes 4 times less Vitamin D than at age 20)
  • The Obese: >50% less bio-availability, 3x higher prevalence of Vit. D Deficiency and 1.9x of Vit. Insufficiency
  • Northern Latitudes: Less UVB Radiation
  • Darker Skin People: Vitamin D synthesis is naturally reduced from melanin (a natural sunblock) and non-hispanic blacks have a 26.4X higher vitamin D deficiency and 3.7X Vitamin D insufficiency vs. whites
  • CDC found 14% of COVID-19 patients were obese, 33% were African American, and more likely in elderly (only 45% among White people who are 76% of Americans
  • Strong evidence shows that Vitamin D is protective for respiratory tract infections
  • 25 randomized clinical trials showed the daily or weekly supplementation reduced risk by >50% is patients with the lowest Vitamin D levels at baseline (10% with higher baselines)
  • ACE2 works with ACE and they need to be balanced, when not it can result in lung, heart, kidney injury and others (renin angiotensin system)
    • The renin angiotensin system is severely unbalanced during cytokine storm
  • Vitamin D can help with this balance by increasing ACE2 receptor levels and down regulating Renin (during acute lung injury)
  • Supplementation: 1000iu of Vitamin D increased blood levels by ~5 nanograms per ml. (unless you have a genetic variation)
    • Best to test blood levels before/after supplementing (not feasible with COVID-19 at the moment)
    • Rhonda take 4000iu’s per day from Thorne and levels are 50 namograms per ml.
    • Don’t take too much! Max for adults is 4000 iu’s per day
  • Summary: Most people are deficient in Vitamin D which could play a key protective role in acute lung injry and ARDS by regulating the Renin-Angiotensin System when ACE2 is decreased)

Could Sauna Help To Prevent COVID-19?

  • No data suggests this will help with COVID-19
  • Some data exists on pneumonia/common cold and the immune system
  • Immune System Effects: Sauna has shown a reduction of risk by creating mild hyperthermia, reduced oxidative stress on the lungs and associated inflammation
    • 2,000 patient study of 20 min sauna sessions at 174 degrees (Finland)
    • Frequency of sauna use was inversely correlated with acute illness
    • 4-7x per week were 41% less likely to develop pneumonia
  • May also improve lung capacity, tidal volume and other measures
  • Heat Stress/Dry Infrared Sauna has also shown to help with COPD (140 degrees, 45 minutes)
  • Heat Stress/Sauna leads to release of Heat Shock Proteins that are critical to protect cells in stressful conditions (these decrease with age) – also trigger the innate immune response
  • Hot Baths (easier to access now…) have also been shown to increase heat shock proteins) – 104/5 degrees
  • MORE Rhonda Patrick notes on Sauna

Can High Dose Intravenous (IV) Vitamin C Help to Treat COVID-19?

  • No published data on COVID-19
  • RCT trial in China started in Feb. for severe patients – 12g of IV Vit. C 2x a day – to complete by Sept. 2020
  • Anecdotal evidence from China, NOT peer reviewed and posted online
  • Oral vs. IV: IV is much more bio-available (30-70x higher than oral)
  • Vitamin C for Sepsis
    • Low vitamin C is common in Sepsis and IV Vit. C might be a good treatment for Sepsis (176 patient, RCT, IV Vit. C or placebo) had a 30% death rate vs. 46% on placebo, fewer ventilated days and fewer days in hospital
  • Vitamin C as an Anti-Viral: Assumed to due it’s effect on the immune system and to directly produce Hydrogen Peroxide (which can kill unhealthy cells, but not healthy cells)
    • Vitamin C is highly concentrated in immune response cells (e.g. neutrophils) which products those cells from damage
    • Can also help with T-cell generation and preservation
    • Can prevent replication of viruses

Could Melatonin Be a Potential factor for Severity Via its Effects on Inflammation and Oxidative Stress?

  • NO data that it can help with COVID-19
  • Melatonin is a hormone that impacts many genes in the body, in particular the circadian clock
  • Melatonin decreases with age
  • Melatonin can act as a regulator for the immune system to turn it up when needed and down when it’s too high
  • Has been shown in animal studies to product from lung injury from viruses
  • Clinical Studies: Can be helpful in newborn lung infections
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