May 15, 2020

Dr. Rhonda Patrick on The Joe Rogan Experience #1474

Key takeaways

• There are components to our immune system we can control:
  • Vitamin D levels: this might be a good time to supplement while we are indoors more often
  • Sauna: if you have access use the sauna regularly to improve cardiovascular health and immune functions – take a hot bath if you don’t have access
  • There’s a big difference between oral vitamin C and Intravenous vitamin C
    • You can take vitamin C orally but will need a big dose and it still won’t have the same effect; IV once per week if you can
  • Zinc + quercetin are an effective combination for stimulating antiviral activity and improving immune function
  • Sleep plays a crucial role in immunity, homeostasis, and regulation of body functions
• What is on the Horizon in Terms of Treatment?
  • People are actively working on monoclonal antibodies
  • Improved therapeutic treatments coming, including more repurposing of drugs that will make things less scary

Introduction

• Dr. Rhonda Patrick (@foundmyfitness) is a Ph.D. in biomedical sciences and the founder of Found My Fitness
• Host: Joe Rogan (@joerogan) 

Immune System Function and Relationship to SARS-CoV-2

• What can you do to strengthen immune system?
  • As you get older your immune system declines
  • There are lifestyle components of immune system you can be proactive about: exercise, sleep, supplements, nutrition, gut-microbiome health
• Immune system function and previous virus exposure
  • Besides age, the major regulator of immune function seems to be previous virus exposure, not genetics
    • At any given point you have antibodies against 10 different viruses but you’re not always getting sick
• Cytomegalovirus (CMV) and SARS-CoV-2
  • 50-80% of US population has had CMV and most people don’t ever know they have had it and show no symptoms 
    • CMV impacts immune function differently depending on when you get it
      • When you’re young, it enhances immune response but for older people it’s deleterious
    • Interesting tie-in to COVID-19 because we know older people are more prone to severity 
  • It’s likely that there’s some cross-immunity happening since SARS-COV-2 viruses is part of beta coronaviruses along with SARS-CoV-1 and MRSA
  • 15-30% of common colds come from coronaviruses so there’s a good hypothesis that potentially one or two of common cold virus antibodies could interact with SARS-CoV-2 and neutralize it
• SARS-CoV-2 and antibody dependent enhancement
  • Antibody binds to virus and instead of neutralizing it, changes the configuration so the virus can get into the cell better
    • This activates the immune system and causes pathology
  • This results in a higher viral load without antibodies to neutralize
  • We’ve seen it happen with coronaviruses, including SARS-CoV-1 and MRSA
• Spike region and SARS-CoV-2 mutations
  • The spike region is where antibodies bind and is also the region the virus uses to get into the cell
  • Currently seeing two major strain mutations in the spike regions – one mutation more prominent in Asia, one mutation more predominant in Europe and North America
    • Brings to light an interesting genetic link to mutations
  • There’s a theory that the mutation is causing people’s immune system to become more active and lead to severe COVID-19

Promising avenues for therapeutics

• Monoclonal antibodies: identify specific antibody that binds to spike protein and manufacture them
  • Problem is this will offer short lived protection since you are not making your own antibodies as you would with a vaccine
• Continuous exploration into repurposing drugs and combination drug treatments

Do Ventilators Cause More Harm Than Good?

• Anecdotally, the majority of people on ventilators die partly because ventilators cause more damage to the lungs and can induce more damage
• But it’s hard to say which came first – did the ventilator do the damage or was the damage so severe that the patient needed a ventilator

Is Having Type O Blood Protective Against SARS-CoV-2?

• People with Type O blood seem to be less susceptible to contracting COVID-19
• Mechanism:
  • People with Type O blood create Type A antibodies which bind to spike region and neutralize antibody so it can’t enter the cell  
    • We saw this in SARS-CoV-1 so maybe same for SARS-CoV-2
  • Another (unproven) theory: Type O blood people have lower levels of blood factor involved in clotting

COVID-19 and Prisons

• Hearing more stories that some prisoners are trying to contract SARS-CoV-2 to get out of jail by spitting in a cup and passing to others
• Reportedly, 98% of prisoners are positive but asymptomatic. Why?
  • First off, it’s important to distinguish between asymptomatic and pre-symptomatic 
    • Some people do not have symptoms at the time of testing but develop symptoms later so are actually “pre-symptomatic”
  • It’s possible that viruses have already gone around that environment so antibodies from those viruses are helping in immunity from SARS-CoV-2
  • Rhonda was also searching to literature to see whether inmates are vaccinated prior to entering but couldn’t find that information  

The Importance of Sleep

• Poor sleep has a huge impact on glucose and spikes and also plays a role in maintaining optimal immune functions
• Rhonda takes melatonin to help her sleep, 10 mg/day
• Regulating circadian rhythm is crucial for sleep 
  • Rhonda makes sure to have bright light exposure in the morning (e.g., opening curtains, walking outside), and changes the lighting in the house in the evening to red lights
• Joe’s advice for sleep apnea 
  • CPAP alternative called Full Breath Solution – mouthpiece with tongue depressor that prevents the tongue from sliding back, instead of CPAP machine

Why is vitamin D important?

• Vitamin D is a hormone, impacting 5% of human genome and crucial for lung and respiratory functions
• Vitamin D deficiency
  • 70% of US population has insufficient Vitamin D levels; 28% are deficient
  • Body can generate naturally when exposed to sun daily
  • Elderly people are more deficient
  • Obese people in US are also more likely to be vitamin D deficient
• What is happening in the body that’s causing people to be vitamin D deficient?
  • Genetic polymorphisms: people that have variations in genes that cause them to have less vitamin D
    • These people are more likely to die from respiratory infection
  • African Americans in the US are 28x more deficient in vitamin D than Caucasians
•        How are vitamin D and SARS-CoV-2 related?
  • A recent study that looked at COVID-19 patients observed an inverse relationship between vitamin D levels and COVID-19 symptoms: the lower the vitamin D levels, the higher the severity of COVID-19
  • In Indonesia almost all patients that died from COVID-19 were vitamin D deficient
  • Melanin blocks ability to produce Vitamin D
    • In the US and Europe, African Americans and black people are more likely to die from COVID-19
    • Even when adjusting for SES and lifestyle factors, this was still true so something else must be happening 
• Hypothesis needs to be tested about correlation between vitamin D and COVID-19
• Vitamin D dosing
  • Tolerable upper intake is 4000 IUs per day but it’s best to get vitamin D blood test to measure levels
• Therapeutic studies of vitamin D
  • There are clinical studies exploring the role of vitamin D but not many in the US
  • Rhonda wants to see nurses and first responders take vitamin D to see the role in prevention but those studies are not being done

Game Changing Impact of Saunas

• Joe uses the sauna 7 days/week, 180-degrees for 25 min
• Rhonda uses the sauna 5 days/week, 180-degrees for 25 min
• Saunas mimic moderate physical activity
• Heart rate variability improves, blood pressure goes down, cardiovascular health improves, all-cause mortality decreases
• Sauna use also improves immune system and makes you more resilient against infection
• Brain-derived neurotropic factors (BDNF) increases with exercise and heat stress (sauna)
  • BDNF regulates neuroplasticity, the brain’s ability to adapt to changing environment
• The positive benefits of physical activity on the cardiovascular system were enhanced when sauna was added
  • Association between sauna bathing and fatal cardiovascular and all-cause mortality events by Laukkanen T, Khan H, Zacardi F, Laukkanen JA
  • Cardiovascular and other health benefits of sauna bathing: A review of the evidence Laukkanen JA, Laukkanen T, Kunutsor S
• Heat shock protein, sauna use, and immune system
  • Sauna use increases heat shock proteins which prevent muscle atrophy, neurodegenerative genes, and have anti-depressant effects
  • People who sat in 160-degree sauna for 30 minutes had a 60% increase in heat shock protein compared to baseline
  • Large Harvard study being done to assess whether hot yoga increases heat shock protein
  • Heat shock protein have antiviral activity against influenza A 
• Infrared vs standard dry sauna vs hot bath
  • Regular sauna is heating ambient air which in turn raises core body temperature
  • Infrared saunas are directly heating body without heating the ambient air – for example, in a heating tent or blanket
  • We know more about the effects of dry sauna
  • For people who don’t have access to sauna, a hot bath is a good modality for heat shock protein
• Future direction of therapeutic uses of saunas
  • Studies being done to assess whether sauna can have anti-depressant effect on depressed patients
  • Saunas could also provide an avenue for giving sedentary and disabled people the benefits of physical activity without exercising

Cold Shock Protein: Ice Bath and Cold Shower vs Cryotherapy

• Ice baths and cold showers can be comparable to cryotherapy but you have to stay in the cold water longer
• How does it work?
  • Cold shock protein hasn’t really been measured in humans, instead what’s measured is norepinephrine which has been shown to increase
  • Cold shock protein and hot shock protein have been shown to improve mood as well

Vitamin C: Oral vs Intravenous (IV)

• The pharmacokinetics of vitamin C are very different in oral vs IV consumption
•  “The difference between IV and oral vitamin C is apples and oranges” -Rhonda
  • Oral vitamin C is good for immune function, etc. but IV vitamin C is for therapeutic treatment
  • IV vitamin C is routinely used for sepsis and has been shown to reduce mortality of sepsis patients, especially in combination with thiamine
  • IV vitamin C has also been shown to improve outcomes for cancer patients and plays a role in fat oxidation
• What about people who argue your body only absorbs a certain amount so there’s no point in taking vitamin C?
  • When taken orally, there is a saturation level so once you go above that you excrete a lot in urine but if you look at plasma levels, you’re still increasing
• IV vitamin C overcomes saturation mechanisms
  • Dosing and Frequency: How often should you receive IV vitamin C?
    • You want at least 10g IV vitamin C
    • It’s not something you do daily, it’s more for a purpose such as fighting the common cold; somewhere between once per week and once per month
    • Rhonda was receiving once per week prior to shutdown

Zinc and Immune Function

• Zinc is important for immune function and has been shown to dramatically decrease duration of common cold
• Zinc is readily available in meat and poultry so there isn’t a lot of zinc immune deficiency in the US but vegetarians are more prone to zinc deficiency
• Zinc is a positive ion so you want to supplement with quercetin
  • Quercetin is actually known to have antiviral activity against SARS-CoV-1
  • Quercetin has been identified as a possible compound that can clean out senescent cells (non-functioning cells that secrete cytokines and things that age in cells)

COVID-19 and Kids

• A lot of studies looking at children that are asymptomatic, symptomatic, uninfected
• Children that are asymptomatic are shedding as much virus as children that are symptomatic and adults that are symptomatic

Other COVID-19 Thoughts

• Joe regularly tests himself and tests everyone that goes into the studio
• Should we wear masks?   
  • The cloth mask is to prevent you from spreading, not necessarily as protective against breathing in droplets
  • If you’re asymptomatic, a cloth mask will help in preventing spread

Miscellaneous

• Can chewing gum kill cavities?  
  • Xylitol gum kills s. mutans, the bacteria that causes cavities
  • Studies showed that women who chew xylitol gum during pregnancy improve the microbiome of their mouth and have children with lower incidence of s. mutans as measured by oral bacteria