Dhru Purohit Show - #236: How Poor Metabolic Health Allows Covid-19 to Hijack Our System with Dr. Ronesh Sinha

Starting point is 00:00:00 I no longer think of COVID-19 is a transmissible infection. I think of it as being a transmissible metabolic disorder because of the impact it has on our metabolism, which unfortunately can be lasting even after the infections cleared. Hi everyone, Drew Brod here on today's podcast. We're talking about metabolic health. 88% of Americans are metabolically unhealthy. That means only 12% are actually healthy. And I believe, and our guest believes today, that that,

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Starting point is 00:04:31 Perot podcast. Each week we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. On today's episode, we've invited Dr. Ron Sinha to have a layered and hard-hitting conversation on what I personally think, and he thinks, is one of the biggest missing links when it comes to the COVID-19. pandemic, and that's metabolic health. Now, before I tell you about Dr. Ron, I want to give you a little background. According to a study published in 2018 in the Journal of Metabolic Syndrome and Related Disorders, up to 88% of American adults are metabolically unhealthy.

Starting point is 00:05:13 88%, which means only 12% are metabolically healthy. That shows you just how big of a problem this is. Now, the link between obesity and COVID-19 is well established, with the data showing the most severe hospitalizations and even debts, which are super tragic, by the way, of course, occur in these populations with higher rates of obesity, not all, but most. Now, what hasn't gotten as much attention is that metabolic health is the system that this opportunistic virus is taking advantage of to wreak its havoc. Now, you see, poor metabolic health can promote a chronic inflammatory state in the body.

Starting point is 00:05:58 It can also weaken the immune system through multiple mechanisms, including disrupting the gut microbiome. It also promotes an oxidative stress state, which is an overabundance of damaging free radicals in the body. When our metabolic health is poor, everything our body does becomes harder and our immune system becomes vulnerable. Now, to set the stage for today's conversation, it's important to note that I'm recording this interview with Dr. Ron in late August, 2021, in the midst of a summer surge for COVID-19. Now, it's not just the United States that's going through a summer surge. We also have some countries in Europe that have high vaccination rates like Israel that are also going through a summer surge. And while the data does show that vaccines protect against severe hospitalizations,

Starting point is 00:06:51 and death, I think it's fair to say that the CDC and pharmaceutical companies have been a little bit caught off guard that the real world efficacy of the vaccine isn't as strong as it was touted to be in the original clinical trials when it came to the spread of COVID-19. That's why this topic of metabolism is so key. Whether someone is vaccinated or not, improving your metabolic health is one of the number one things that you can do to protect yourself not just from COVID-19, but also from every other chronic disease that's out there. On the flip side, if you have poor metabolic health, listen up. And it's not just if you're obese. If you have poor metabolic health, you can be skinny.

Starting point is 00:07:37 You can be normal weight and have poor metabolic health. And you've decided not to get the vaccine. I think this conversation might be eye opening and you could end up giving. it a second look. Lastly, before I tell you a little bit more about Dr. Ron, I want to say that the world looks like it's in chaos right now and extremely tribal if you turn on the news or pay too much attention to social media. And in my opinion, one way to bring more calm and peace to this world is by having layered and nuanced conversations with people who can present data without trying to freak you out or any other ulterior motives. And that's my hope for today's conversation. Now, a little bit about my guest. Dr. Ron Sinha is an internal medicine physician who runs a

Starting point is 00:08:28 lifestyle clinic in Silicon Valley focused on reversing insulin resistance in ethnically diverse patients. He's also an expert in corporate wellness and serves as a chief medical officer for Silicon Valley Employer Forum, where he serves as a global, advisor to shape health benefits for over 55 major Silicon Valley companies. His groundbreaking work in corporate wellness and raising awareness around insulin resistance in the Asian population has received global attention with front cover stories in Fortune magazine and the LA Times. Dr. Ron Cena blogs actively on health at cultural healthsolutions.com and recently

Starting point is 00:09:11 launched an incredible podcast called Meta Health Podcast. where he uses creative storytelling to teach listeners about health and metabolism. To start off the interview, I asked Dr. Ron to riff a little bit about my comments in the intro that I just shared with you and to share his own take on COVID-19, metabolic health, and the current state of the world. Let's listen in. And really with COVID-19, you've interviewed a lot of great scientists as well, too. And we know that we've got to, we're playing catch-up all the time. And this virus changes faster than any modern sinus we could put behind it.

Starting point is 00:09:47 So we have to come to some sort of uniforming approach to how can we keep our population as healthy as possible, whether they're vaccinated or not vaccinated. And you already alluded to this. We're finding, and I'm seeing some of the first cases in my own practice, of individuals that are vaccinated that are still having issues with COVID-19. We're going to hope that's going to continue to be a very minority case. But like you said, Drew, we don't know. This is a moving target.

Starting point is 00:10:10 that each mutation can present something that's completely different than what we expected. And from a mental standpoint, too, if we keep thinking and telling ourselves that it's over, it's almost over, we're just going to set expectations to be disappointed, and that's going to cause a lot of mental health issues for us. So my approach always in my personal life and with my patients, my audience, is let's expect the worst right now and just prepare our bodies as much as we possibly can to do the things that are most important for really improving our response to the virus. So I love the fact that you reached out to me to talk about metabolism because one catchword that I use is I no longer think of COVID-19 is a transmissible infection.

Starting point is 00:10:48 I think of it as being a transmissible metabolic disorder because of the impact it has on our metabolism, which unfortunately can be lasting even after the infections cleared. So I think this is a great time for us to both dig into the science and not really raise fear, but just educate people about the science so they can do things to be prepared and mitigate any of the consequences that come up with COVID-19. Yeah, and before we jump into metabolism and a little bit of a refresher of some of the things that we talked about in the beginning, you know, insulin resistance and the connection between the body and all those mechanisms that you have so many beautiful analogies, rather, to describe, I also want to start off with a couple other pieces that are there is that, you know, often well-meaning and well-intention, you'll see these stories that get shared on the media about individuals that, you know, who are, you know, who are,

Starting point is 00:11:39 who have gotten, you know, sick or have gotten COVID. And in some cases, are on a ventilator or who passed away. And sometimes the narrative that's there, and by no means, there have been young, healthy people that have gotten sick with COVID, that have died, that have passed away. That's absolutely a part of the equation. Sometimes, though, as used to what I would say to convince people to get vaccinated, there is a story of that all the folks that are young, that are on a ventilator and dying from COVID-19 are healthy because they're young and that

Starting point is 00:12:15 there's nothing else going on because they might not have a diagnosed, you know, comorbidity. But many of those could still be having challenges with metabolic help. So both, as you mentioned earlier, with vaccinated and unvaccinated, it's so important to understand that just because even if somebody's young, that doesn't protect them necessarily from having poor metabolic health. That's such a great point because, you know, the way we currently define metabolic health, and we actually in medical practices don't really use the word metabolic health, right? We're very disease-focused.

Starting point is 00:12:47 So by the time we're downstream from aberrant metabolic health, then we're looking at conditions if they're at the pre-diabetes or the type 2 diabetes level. But you're right, in my practice or, you know, like-minded folks at practice like I do, we're looking for the earliest signals of metabolic disruption. That's not a mainstream part of medicine. And so part of our job today is to really educate people about that. And again, not to create fear or paranoia, but just more knowledge about your body. And what are those early signals that I might be having an issue with metabolic health?

Starting point is 00:13:16 And that's important regardless of COVID-19, but especially in COVID environment, we've got to make sure we really act on those signals. So let's start off on the basics. When somebody asks you, okay, what is metabolic health and how is it related to this whole conversation of COVID? How do you start off from there? Yeah. I mean, first, like, let's just simplify. the definition of metabolism. And really, it's just our body's ability to produce energy. And there's

Starting point is 00:13:41 multiple processes involved. I'm biased towards insulin, as you know, it's my favorite hormone. That is really one of the metabolic gatekeepers. So if we're talking about how our body cells actually convert food energy into energy that we can use, insulin is one of those key gatekeepers. And, you know, although we've focused on insulin carbohydrates, it's also very important for fat metabolism and protein metabolism. And if we pick up on the fact that insulin is not working properly in the early stages, to me, that's an early sign of metabolic disruption. So just as a summary, and I know a lot of your audiences, they're some experts as well on insulin resistance. But, you know, one of the key things we look at is when you are intaking food, let's say carbohydrates, we really want to make sure

Starting point is 00:14:22 the majority of those carbohydrates are being trafficked into muscle primarily after meals so your muscle can clear that glucose and convert it into energy or store inside those muscles. But when we are having issues with the condition called insulin resistance, which is the most common metabolic disorder, there's a couple of things happening. And then I'm going to connect this to COVID-19 in a moment. The first thing is our muscles and ourselves are not responding to that insulin signal as well. So they're not able to pull the glucose in. And then the second thing is our pancreas, the beta cell specifically in the pancreas that are the insulin-producing factories. Initially, they're actually producing a lot of insulin to respond to that insulin resistance. But

Starting point is 00:15:02 eventually they burn out and they produce less insulin. So one analogy I use for beta cells is they're kind of like your battery cells. And they've got a fixed battery duration life. And we want to preserve that battery life as much as possible. But when we wear out those battery cells, then we're not producing insulin. And that's when really diabetes can go haywire. So that's sort of the spectrum of what we think of with normal metabolic health versus disrupted metabolic health defined through insulin resistance window. And then understanding how COVID-19. interferes with that process is really an education in itself, and we can definitely transition to that. Yeah, I would love to talk about that. And let's jump right in. How is it that this COVID-19,

Starting point is 00:15:43 which is really an opportunistic virus, can hijack poor metabolic health and inflammation can run rampant inside the body? Yeah. So, you know, I think a lot of us are already familiar with what you beautifully stated before, that if you have signs of insulin resistance already, type 2 diabetes, hyperglycemia, obesity, high triglystriads, low HDL, your risk of having a COVID-19 complication is much higher. But now what we're looking at, there's less data around this, but there's emerging data, is what about an individual that really doesn't have any of those signs, but they come down with COVID-19?

Starting point is 00:16:17 What are the downstream consequences of that? Now, in my practice, I don't define myself, by the way, as being a COVID-19 frontliner. My hats off to all of those in the hospitals that are fighting this infection directly, but I do have a practice that's focused on metabolic health. And a lot of my patients were continuous glucose monitors, which I know you've talked about in-depth, CGMs. And some of the interesting things I'm seeing is, number one, during the shelter in, many of my patients that it actually ramped up their lifestyle changes.

Starting point is 00:16:43 Some of them developed pretty significant A1C elevations, which is our marker for glucose control. Their continuous glucose monitor data actually started looking worse despite making these changes. And these were patients that were actually diagnosed with COVID-19. I had a handful of those anecdotes and I looked deeper into the research. And then I realized that, wow, COVID-19 really is doing things to that insulin mechanism that is putting people at risk for future type 2 diabetes. And one of the analogies that I use here, it's kind of like gestational diabetes. I've had a lot of women in my practice had developed gestational diabetes.

Starting point is 00:17:17 And Drew, they had no clue of having anything related to insulin resistance. Some were very fit and healthy. All their markers were normal, but pregnancy unmasked in underlying insulin-resistant tendency. We're seeing something similar with COVID-19 where it is unmasking potentially some underlying insulin resistant tendencies or it's taking even normal people that are normal by all criteria, including CGM, and presenting nuance at insulin resistance and metabolic disruptions. Now, the mechanism for this is very interesting. Remember, I told you there's two arms to this insulin issue.

Starting point is 00:17:48 The muscle is not responding to the insulin signal and then also the beta cells eventually getting hyper-stimulated and burning out. The thing about COVID-19 is when it enters our body, a lot of you might be aware of the fact that it basically invades our cells through a gateway called the ACE2 receptor. And there are certain parts of her body that are more permissive to COVID-19 than others. So we know about the lungs being very permissive, the heart, which is where we see a lot of symptoms. But what a lot of people aren't aware of is our beta cells that produce insulin, they've got

Starting point is 00:18:17 ACE2 receptors, and they're unfortunately very welcome to the COVID-19 virus. When the COVID-19 virus enters our beta cells, it causes hyper-stimulation of the beta cells, so you're producing a lot of insulin, that hyper-insulinamic state. It also triggers an autoimmune reaction where the beta cells are being attacked, kind of like a type 1-type diabetes autoimmune effect. So already directly, and in the autopsies of COVID-19 patients, you can see all these features where you've got these heavily infected beta cells that are really disrupting the way that beta cells can produce insulin.

Starting point is 00:18:51 So that's one arm of the equation. At the same time, what COVID-19 is doing, it is actually interfering with insulin signaling pathways. So when the insulin hormone attaches to that receptor, it should send signals to the cell to pull sugar in. It's actually causing that cytokine surge, and the cytokines are actually interfering with that signal. So on both ends of the spectrum, it's causing type 2 diabetes like insulin resistance.

Starting point is 00:19:15 It's causing type 1 like autoimmune attack on the beta cell pancreas. And the problem here is you might think when the impact, Infections gone, I'm not going to have any issues. But beta cells are not easily reversible. They don't just come back when they're gone. There are some studies that show maybe fasting, mimicking diets and ketosis can bring back some of those beta cells. But once you lose them, you pretty much lose them. So one of our jobs, again, coming back at that battery cell is what can we do now to proactively protect our beta cell battery cells? So even if we take a hit from COVID-19, we're going to have sufficient amounts of battery power to really promote longevity and adequately. glucose control over the lifespan. Yeah, I think there's so many beautiful takeaways that are in there. You know, what I'm hearing is two main ones that I want to highlight here. Number one, we're here to talk about how poor metabolic health from the beginning and insulin resistance as something that might be there, whether recognized or not, could make somebody

Starting point is 00:20:13 more likely to get COVID in the first place. But if you're also borderline and then you get COVID and you get an infection, if you still haven't improved your metabolic health, even if you're vaccinated, then you could be pushed in the direction of these beta cells not working at the best level and maybe even propensity towards autoimmunity. Is that what I'm hearing, that you have both sides? Love it. Exactly right. You've got both sides of the equation. I think so important, especially again, you know, Israel was touted as sort of a model for, you know, the vaccine rollout and everything there. And I think that they're in the 80% range of, you know, the rollout for

Starting point is 00:20:55 vaccinations throughout Israel. And they're a leading marker, especially as we gear up for what is typically a winter surge. Right now, we're having a summer surge at the time that we're recording this podcast. And the Israeli health minister recently was quoted. And there's a science magazine. I'll link to it in the show notes. There was an article where they were saying, you know, this is a grim warning that the vaccinations blunts, but do not defeat the spread of COVID. And of course, we have the data that vaccinations, for sure, reduce severe hospitalization and death. And I think the context that we can take away from that article and the warnings out of Israel, on top of this conversation that we're having here, is that, you know, if we're all, chances are that we will probably get COVID at some point,

Starting point is 00:21:46 in time. We want to make sure that we don't fill up the hospitals. We want to make sure that we don't have that risk of severe hospitalization and death. But because COVID is going to be around, if you are in this vulnerable state of poor metabolic help and insulin sensitivity inside of your body where you have insulin resistance, you could get very sick both in terms of getting the virus or even if you get the virus, it's going to make you worse off. So it all just all roads come back to, it's time to improve our metabolic health. I totally agree. And actually, as you've been talking through that, I just wanted to bring up the point that you're right, that so far, thank goodness, that the COVID vaccine is good at bringing down severe hospitalizations. But the data

Starting point is 00:22:30 that we don't have is, is there an in-between zone where even though it's reducing or limiting my risk of hospitalization, am I somebody still who is at risk? Do I have some infected beta cells, which might put me in this intermediate gray zone where I present with something later on? So, again, coming back to a point about defining metabolic health as early as possible, this is where I'm encouraging my patients, my corporate audiences who've actually fallen off the bandwagon with their preventive health to get your baseline numbers check now if you've been postponing that. Get your A1C, your glucose check. If you can convince your doctor to get a CGM on, because there's an Italian study that's

Starting point is 00:23:07 done very eloquent work where they don't just look at the standard markers, but they actually looked at CGM data, and they already noticed trends in glucose variability and all the glucometrics that we look at with CGMs, and they detected these early changes. So this is a time for patients and physicians to be very proactive in picking up on those early sensors. So then we can track that over time and see, are there any disruptions that are taking place. I want to go back to a point that you made earlier when we were chit-chatting a little bit before we hit record. And you were saying that, you know, you feel that there's, you know, again, our hats off to everybody that's on the front lines, doctors, nurses, practitioners, they're overwhelmed right now.

Starting point is 00:23:45 a lot of layers to that conversation that are there. And there's naturally a building of a whole host of feelings, including frustration and other things like that. And you had mentioned that one of the unique challenges that we're in right now is that the conversation seems to be focused around vaccines or bust, right? It's all about the vaccines. And then there's not much outside of the integrative community talking about the other areas that can be a protective layer because sometimes physicians might look at a patient who is, let's say, overweight or obese or doesn't have great lab results when it comes to all the markers around metabolic health. And they feel a little bit powerless in terms of what they should be recommending to them.

Starting point is 00:24:40 And there's a little bit of societal expectation of, well, this is just normal now. I'd love you to riff on that and talk about this unique and challenging place that a lot of practitioners find themselves in, but how it also needs to be addressed. Yeah, it is. It's a challenging space to be in. And I'll be the first to admit that when I first came out into practice, I was sort of guilty of taking my patients that were very noncompliant with my advice, whether it was lifestyle going on their blood pressure pills or cholesterol pills. If they didn't listen to me, talking to my colleagues at some point, I was like, if they're noncompliant, then they're probably not going to be well taken care of by me. Sometimes I would actually remove them from my practice. But now as I evolved through this, I realize that those are sometimes the patients that need the most help from us. So if we have patients, and I have a few my practice that have openly told me they don't feel safe getting the vaccine. And I got to say early on in the phase, I also was like, how could they be doing this as a public health hazard? You know, what are we thinking by actually not taking advantage of this vaccine?

Starting point is 00:25:37 But now I'm realizing that those individuals, if they have those thoughts around the vaccine, I still have to do an extra good job of making sure that they're red about. health is good because they're not getting that protection from the vaccine. So I've got to focus on insulin resistance on mitochondrial health, first for the sake of the patient. But also it's going to be a community thing as well, too, because if they're metabolically healthy, even without the vaccine, their chance of occupying a hospital bed is going to be far far less. So I really hope that at some point we can evolve out of this polarity. And as health care providers, you know, we have rifts and families and communities between friends on this. You know, can we come together and at least agree that there are some really solid, fundamental things we can do around mitochondrial and metabolic health that

Starting point is 00:26:19 can help the whole population, whether they're vaccinated or not. It's such an important point. And I think that, you know, there's a lot of great media that's out there. And naturally, you know, if it leads, it bleeds. And polarization is good for ratings. It's good for, you know, ad dollars. And it's nice to see a lot of alternative forms of media popping up. I even saw, I know you're close friends with him. a really great interview with Z-Dog, is that how you say it? Yep, Z-Dog, yeah. Where he was coming out and saying, you know, I was feeling initially when I would hear

Starting point is 00:26:57 about the large groups of people that were saying, you know, the reasons that they didn't want to get vaccinated, which, by the way, you know, just so people understand, that also includes in that group. It could be people for religious reasons. It could be people, you know, Native Americans. that have, you know, there's a small vaccine uptake in those populations. There might be some distrust that's there with the government, right? There's a whole bunch of reasons why people might have some vaccine hesitance.

Starting point is 00:27:27 Anyways, he was saying that, you know, he really thought that shouting and blame and that was the way to go at it. And then understood that really if we could just honestly have a conversation with people, meet them where they're at, not shut them down, do all the things that can you imagine you open up to a friend And then they tell you, you're terrible, you're ruining your life, whatever it is. You're not going to listen to them. And there's some really great articles that have been written recently by a whole host of folks in public health and epidemiologists that are embracing this and saying, from a public health standpoint, if the goal, right, the goal is to get the population healthy and get on the other

Starting point is 00:28:05 side or at least understand the context of the pandemic and reduce as much harm as possible, which means total harm. not just the harm of COVID, especially when it comes to kids, it's total harms that are there. Then we have to take a multi, multidisciplinary approach and double down into the education of how people can, you know, make themselves healthy. So I think that it's an important piece. And I applaud you for talking about it as a physician because I can tell you that a lot of people feel that way, but they're scared to talk about it because if there's any sense that

Starting point is 00:28:41 they're not putting all their attention on the vaccine, which I totally get, there's a risk of feeling like you'll be chastised by your peers or canceled because you're talking about alternative options. Yeah. And you know, with my physician colleagues, quite frankly, when I have the discussion, I tell them that they need to protect their own, you know, I call it the three Ms. When I give corporate talks, I'm like there's three fundamental Ms that I see deteriorating out in the place because of COVID-19. It's metabolism. It's musculoskeletal because people's postures are developing chronic pains from them. And the third is mindset and mental health. And if we're constantly in this sort of anger mode, we know from just the emotional immune

Starting point is 00:29:19 access, whenever we feel anger, you know, fear, all these emotions, it causes a rampant acceleration of cytokine production by the immune system, which is the last thing you want if you're going to be experiencing an encounter with COVID-19. So we have to be as scientific as possible. I actually stopped looking at Apple News on my phone. I'm looking at mostly scientific resources. I tell people really try to be a scientific, and that's why the education I do, I try to ground it in science rather than a lot of the emotional messages that are around this. And that helps protect us, actually,

Starting point is 00:29:50 because if we can take a scientific more of an evidence-based approach to this, we're using our prefrontal cortex. And that doesn't hyper-accelerate the immune system. We're all emotionally human beings, so we're going to feel that, but I'm constantly reframing myself several times a day that I know this is happening. I just read the scary article about what's happening with kids now. That's scary. I can feel that. the emotions, but what's my next step? I want to educate the community. I want to learn more about what's happening. Try to put on that scientific hand as a doctor, as a parent, whoever's encountering this, because these news headlines are not going away anytime soon. So we've really got to think what that rational brain is off as in as we can. There was a CEC report. We'll link to it.

Starting point is 00:30:28 A friend of ours, Sean Stevenson, on the Model Health Show, covered it on a solo episode on his podcast this past week, saying that after obesity, that they actually recognize, the CDC in a paper that they published that fear and anxiety was a major driver of risk of severe COVID. So it's not just an anecdote that's out there. I'll send you to the link to this. This was super fascinating, the documentation around this. And I really applaud Sean for going into it and, you know, chatting about it because being fearful, being constantly hyper-anxious, that has its own consequences. And regardless of what route we, get a chance to take. We want to make sure that we step away from that. You know, you mentioned,

Starting point is 00:31:13 you read an article about kids. What have you been seeing and paying attention to when it comes to kids and metabolic health? And primarily in the context of even before the pandemic, we already knew that, you know, diabetes amongst kids was on the rise. Metabolic health amongst kids was on the decline. What have you been seeing and noticing as you pay attention? You know, you know, diabetes amongst kids was on the rise. to this conversation of COVID-19 and kids. Yeah. So, you know, in my practice, I'm looking at the literature and comparing it to what I see in my practice.

Starting point is 00:31:47 My practice, I do see some teenagers. And definitely we know from signs that even kids that are experiencing insulin resistance early on, they have a lot of the similar features that adults have. So cytokine-induced inflammation, you know, a lot of the risks that we talk about with insulin resistance, we're seeing kids very early on. We don't have enough data sets yet. But from what we've seen so far, it looks like obesity. early insulin resistance also can increase that risk in kids. In teenagers, interestingly,

Starting point is 00:32:14 we're also finding that teenagers that are especially not aerobically conditioned well, so, you know, we would refer this as being your VO2 max or your aerobic capacity to exercise. It looks like they are having more significant issues with COVID-19 infections, and that doesn't necessarily mean they're in the hospital, but they're having longer issues with breathlessness. They've actually looked at some studies in school teams where in young and even in teenagers who got COVID-19, when they actually methodically measured VO2 max in some advanced labs, they found that even after recovery, some folks did actually have a deterioration in their VO2 max. It was subtle, but it was persistent for a few months. So even in our healthiest,

Starting point is 00:32:57 we're seeing some of these impacts. So now I'm actually going to schools and high schools to educate folks about this, the importance of really preserving aerobic functioning, aerobic capacity because we want to, again, like I said, with the beta cell battery reserves, we also want to improve our lung reserves because our lungs are so vulnerable to this infection. So I think a lot of the theories and concepts we apply to adults from all the data that we have, we can apply to kids. But obviously, let's hope that they're not going to have the same sorts of numbers because there's other elements of their immune system, which at this point are more protective.

Starting point is 00:33:26 Yeah, that's a great overview. I'll also share and add into it. the journal of pediatrics, which is the official journal of the American Academy of Pediatrics, they had a report published on August 12th called Debtes in Children and Adolescence Associated with COVID-19 and MISC in the United States. And they were looking at the data set primarily between February 12th. This is pre-Delta search. So February 12th of last year to July 31st of 2020.

Starting point is 00:33:59 So February 2020 to July 20, 20, 20. to July 2020. And it's an important thing to note. And again, the data that we'll see that comes out of the Delta wave, we'll add more to it. But it's very telling to understand that metabolic health across the way is such a huge factor for anybody that ends up. Unfortunately, and it's heart-wrenching and you wish it was zero, but unfortunately, metabolic health plays a major role when it comes to the debts that we're seeing. So out of that report,

Starting point is 00:34:33 which we'll link to in the show notes, what the study found, the American Academy of Pediatrics, was 86% had at least one underlying condition, even amongst kids. And this was looking at kids 18 and under. And just so everybody understands, in the U.S., it's around 70 to 74 million kids that are 18 and under. And this report, found that in that time period, I forgot exactly what the total number of deaths were since the pandemic is start. It's around 385 deaths as of last week. Again, every death is super sad, but still, I would put that in the category of one of the,

Starting point is 00:35:16 not the top leading death for kids in that category compared to car accidents and other stuff. But again, every death is a terrible death of COVID, just so everybody's clear about that. So 86% had one underlining condition. Obesity being the biggest one, 42%, asthma being the second biggest one at 29%. And development disorders were the next biggest category at 22%. On top of that, I wish we had all the metabolic numbers that you typically look for in your practice. We don't really collect that sequentially through all the different states that are there. One day maybe we'll collect that and we can more fine tune.

Starting point is 00:35:52 And I would imagine hopefully one day in the future as we continue to evolve medicine that there would be a better test that could help you understand, you know, how likely would you to be to fight off or beat if you got it an opportunistic virus. We don't have that right now. So we have to deal with kind of the big picture data that we have access to at the moment. Hey, Drew, so one point I want to make because I know the obesity issue, you know, It's something I've highlighted, but I also have some angst around it, too, because we know a lot of individuals, they're struggling with severe obesity. They're in a stressful environment, and they're not going to be able to come down to, let's say, normal body mass index and waist circumference. And they've developed, quite frankly, a little bit of a fatalistic attitude around COVID-19. But one thing I want to be clear about, because this has not been teased a part in the literature, is we do have individuals that are overweight by body mass index and waist circumference criteria.

Starting point is 00:36:48 They're actually in very good shape aerobically. So I think sometimes we have to uncouple the extra body mass index or the extra fat mass from the fact that still, I think, based on the science that I've seen and my gut instinct, is really that VO2 max in aerobic capacity is probably going to be a major protector for COVID-19. I want to explain a little bit of the science behind that. Please. When you are out, yeah, yeah, when you're basically out. So one of the things, we keep using the word cytokines. And I shouldn't assume that everybody knows what that is. I know it's in a lot of the mainstream literature.

Starting point is 00:37:18 but cytokines are basically chemical messengers in the body. We need cytokines are part of our innate immune system to fight off infection. But when the cytokines go haywire, that's the term that we use for cytokine storm. So whenever we're under some sort of stress, whether it's emotional or physiological, it causes an elevation in cytokine levels. One of the greatest stress is our body, probably the single greatest stress we can put our body through is hypoxia, which is a low oxygen environment. If you put a bag over my head right now, my cytokines are going to go.

Starting point is 00:37:48 go through the roof. And the reason for that is there's a chemical called HIF1-Alpha, HIF-1-Alpha. It's called hypoxia-inducible factor. So when we're in a low-oxygen environment, that protein gets activated and it turns on the alarm on cytokines. So very early on in this process, when I started looking at that literature, my goal with my patients was to get them more aerobically fit, because when you're aerobically fit, what happens is you're more resistant to feeling that sensation of breathlessness. If somebody's out of shape, they go up a flight of stairs, they get out of breath. They walk around the block, they're out of breath. So my number one goal was not for you to lose 30, 40 pounds. It's can you walk, lightly jog or do some cardio activity

Starting point is 00:38:27 and feel less breathless. Now, a biohack that had to do this, even before COVID-19, I was actually exercising two to three times a week with a $50 high altitude mask. So I'd literally put this mask on and get an exercise bike. And it basically recreated a little bit of hypoxia because we know from Olympic athletes that when you train at high altitudes, you actually create more red blood cell mass, more oxygen carrying capacity. And that can protect you against that sensation of breathlessness. So the hack that I use with some of my patients is, hey, you already have to go out there in a mask. When you're walking or exercising in a mask, initially it's going to feel uncomfortable. But as he do that with time, you might find that all of a sudden walking two miles with a mask on

Starting point is 00:39:09 is not that bad. That's a good thing. Because if you get infected with COVID-19 and your immune system is used to the sensation of breathlessness without sending out a panic signal that can really lower your cytokine storm. So as practitioner, as maybe some of us that are struggling with patients that are overweight, they can't lose to wait, I tell my patients, listen, I've got patients in Silicon Valley. They're bringing spreadsheets of all their metabolic numbers for the past 10 years. I tell them, take your spreadsheet and add a column. If you're walking two miles every evening, I want to know what your heart rate is and how

Starting point is 00:39:40 faster you're walking two miles. And I want to see that number improve, because if you're working, aerobic endurance is improving. That's one of the greatest predictors of longevity, reducing heart health. And guess what? Probably COVID-19 complications too. So really building that reserves. Again, I used the word reserve for beta cells. We want to build cardiovascular reserve, lung reserves, so we can handle any potential, lightly breathless situation. So I just wanted to add that spin to it. That's an important part of the equation. And also, you know, you primarily work with, I mean, you work with all different populations, but you are known for a lot of your work in the South Asian

Starting point is 00:40:14 community, especially in the Bay Area. And a phenomenon that we talked about last time that I'm well aware of, because I come from, you know, an Indian background too, is the skinny fat population. So these are people who have, you know, poor metabolic health. You know, they're either borderline insulin resistant or they're, they have it full blown. They are on a traditional body mass index would not be categorized as, you know, obese. And in some cases, wouldn't even be categorized as overweight. Their weight is within that. But they still actually have poor metabolic health and poor metabolic function.

Starting point is 00:40:56 So that's another indication of how you can still have kids that are not in that category, even adults that are not in that category, that they're not obese. They don't have a diagnosed comorbidity that are typically showing up on these reports. And they could still have severe challenges with COVID. Yeah, I'm so glad you brought up the other arm of that. And literally for my clinic last week, I recall seeing a patient who's by BMI standards probably 40 to 50 pounds overweight, but is a marathon hiker. I mean, if I went hiking with this individual, they would outhike me no problems at all, VOT2 max and everything off the charts. But on the contrary, I saw my usual patients in the clinic

Starting point is 00:41:34 that are actually underweight by body mass index criteria. But if you look at their glucose, your triglycerides, I know their exercise capacity based on their sort of physical activity levels, despite them being that much lighter than the other patient, I would be more worried about their risk of developing a severe complication with COVID-19. So again, for population health, we have to use blunt metrics, like body weight, like age as well too, right? We use age as a risk marker too. But I will tell you, I have 60 or 70-year-old elite athletic patients.

Starting point is 00:42:05 And despite them being 60 or 70, I know their mitochondrial health is much better than some of my patients that are teenagers. So we have to look at biological or mitochondrial age versus chronological age. And again, from a population health standpoint, it's tough to sort of tease that data out. But when you really dig deeper into the literature and see the effects on cytokine and immunity, we have to be aware of those nuances for sure. From a public health perspective, I mean, there's so many layers that are there. But if we were talking about in addition to the current policies that exist, if we were talking about improving metabolic health, based on the information,

Starting point is 00:42:41 that's known, and somebody threw you in the position of the Surgeon General, what would be some of the conversations you would be having and talking about from the standpoint of all the experience that you had? I'll tell you a paradigm that I sort of developed that I use with my Silicon Valley companies and with my clients. And I call this the, a simple paradigm is what I call the ABCDs. And I'm going to take you through each of those and feel free to interrupt me if you want me to double down on any of them. The first A.m. is just really activity levels. Okay. So we know a lot of my patients, you know, and a lot of people all across the world now are spending more time in front of a computer and working longer

Starting point is 00:43:21 hours than ever. And we know that prolonged sitting time is actually linked to elevated cytokine increases in obesity and a lot of insulin resistant factors that we've talked about. So when I talk to patients, the first thing I ask him is I don't want to hear about your exercise, your formal exercise, but what is your work routine like? Do you get up in the morning or in front of the computer for hours at a time, or are you interrupting prolonged sitting? And I used to give this lecture all the time even before COVID, because it's linked to heart disease risk, but it's also linked to cytokine release too. So how do we get people to do sit, stand, move in between, you know, obviously meetings?

Starting point is 00:43:56 You know, if you're not on video, can you just pause a video and just sort of do some light jumping jack, squats, et cetera? Because coming back to mitochondrial help, we find that when people interspers physical activity throughout the day, that really gets the mitochondria healthier versus just between one session in the morning or evening and then just sitting sort of still throughout. So that motion is really key. So that's the A part of the ABCDs. I would love to. I would love to just, you know, as you're going through just a couple comments and sort of clarifying questions, you know, contrast that to what seems to be some policies, not all,

Starting point is 00:44:31 some policies, especially here in America, that seem to have unintentionally, reduced physical activity outside. I can think of just recently, you know, the state of Oregon saying that, you know, outdoor mask mandates again. And, you know, especially if we have the data on the vaccines that we have. And then on top of that, we know the likelihood of COVID-19 not being transmitted outside. I'm not trying to call any one person or organization out. I just nice to contrast that against that we may be shooting ourselves, and the foot with some of that, and it should be open for debate on, is it the right move?

Starting point is 00:45:12 I completely agree. And especially in places where I'm hearing about young kids, you know, school-age kids, they're being forced to mask and they're playing in the playgrounds and outdoors. Based on the science out there, I really feel like that is just not warranted at all. So absolutely, I think you're right. When we talked about the issue of national policies, we have to make sure that we're really taking the existing science out there and making sure we're not creating constraints. Because as much as, you know, I talked about, about biohacking and using your mask to exercise. For the average person, it's not fun to be outdoors with a mask on.

Starting point is 00:45:42 It's a one time that you feel like, okay, I want to take in fresh air, even if there's people around me and be able to do that. So it's a really good point around that. We've got to really be more proactive. So that was the A, and I think you're about to jump into the B's. So the B, we talked about a little bit, but it really is the breathing part of it. And I know you've had other probably podcasts with breathing experts, but one nuance I want to put on B for breathing is the way we breathe actually even when we're working.

Starting point is 00:46:06 So coming back to our sedentary workforce. And some interesting things, this is not surprising, but most of us when we're at the computer, especially if we're composing a message, we actually stop breathing. So there's an entity out there called email apnea. And I don't think most of us are aware of it, but when we're at in front of a screen,

Starting point is 00:46:22 we're only breathing shallowly or we truncate breathing completely. Now, what that means is throughout the day, if we're not really taking deep breaths and activating our diaphragm, we're sending a low-level stress signal, again, that hypox-inducingable factor, causing a light cytokine surge there.

Starting point is 00:46:38 So when I say breathing, I mean, breathe better when you're exercising, you know, whether that's nasal breathing, but even at rest when you're doing housework, computer work, et cetera, be really aware of sending deep breaths into that diaphragm. Because one other trick coming back to cytokines is the vagus nerve itself, which is activated by diaphragmatic breasts. The vagus nerve actually blocks cytokine release. If we're breathing shallow up in the upper zones, we're not activating the vagus nerve, so we're not suppressing that chronic side of kind of release. So the B is breathing, being very much more breath

Starting point is 00:47:08 conscious. I love that. No follow-up questions on that one. Okay, good. All right, perfect. So C, and then this is interesting because I've sort of teased this out. So C is really cardio exercise because when I take activity histories in the office, I break it down to the two because like I said, some people might do cardio in the evening or morning, but then they sit all day. So we got to think of interrupting prolonged sedentary periods, but also doing cardio at the right level. And this is a really key point. There is a specific dose of cardiac or aerobic exercise which optimizes immunity and does not cause persistent elevations of cytokines. And that's really what we often call the fat max or the aerobic threshold. The best approach, the simplest approach is what we call the Mathetone heart rate. So full

Starting point is 00:47:53 Mapitone is an amazing endurance athlete and trainer and actually did a podcast interview with him at one point. And his simple paradigm is do most of your exercise at 180 minus your age. So if you're 40 years old, the upper threshold is 140. Now, if you have diabetes, you might have to subtract five. But roughly 180 minus your age is a good threshold. And 80% of your exercise should be in that sub-anerobic zone. That's a key zone where you're going to improve mitochondrial health. You're going to reduce insulin resistance.

Starting point is 00:48:24 You're not going to cause cytokine surges. Now, again, coming back to public health policies, are patients that are, sedentary and not used to exercising, almost any activity they do is going to be anaerobic. If they're wearing a heart rate monitor, even a light walk, getting on a bike or going up a flight of stairs, or joining an exercise class is going to put them in the anaerobic zone. And the problem, Drew, is if you're doing mostly anaerobic exercise like hit camps and boot camps, number one, you're going to cause more cytokine release. Number two, a Swedish study recently showed that people that are getting excessive doses of

Starting point is 00:48:56 high-intensity exercise are seeing mitochondria go down in number. So that's counterintuitive because we talk about exercise being a biogenic factor that increases mitochondrial multiplication, but there's a dose-related effect. If we're doing too much high intensity, we're losing out on the very mitochondria, which we're trying to preserve through exercise. So dosing is really, really key for cardiovascular exercise. And one clarification on that, what do you think, right? There's a buddy mine, Andrew Huberman that we've had on the podcast a couple times, really smart

Starting point is 00:49:27 guy. And he says, you know, he starts off a lot of questions when I ask him, well, I always say I wasn't consulted at the design stage. But if you would imagine, what would be the evolutionary reason that that would happen, that our body under high stress, like a lot of exercise, would actually be reducing or maybe not producing as much mitochondria that's there? Yeah, I mean, basically, it is probably a mechanism for energy conservation. So if you're going through periods where you're expending quite a bit of energy, there might

Starting point is 00:49:57 be some way that we contract some of the mitochondria. And actually, sometimes disposing of mitochondria, when you're undergoing a lot of intense exercise, you're developing a lot of reactive oxygen species, right? So these are basically chemicals that are in excess can be damaging to our cells. So there's actually a process called mitophagy, which is kind of like autophagy, which is cell program death. It's mitochondria program death. So at some point, if the cells under a lot of stress, you might get biogenesis and you might be removing some of those over-exerted mitochondrial engines. that's one of my theories somebody's smarter than me like dr huberman or others out there might have

Starting point is 00:50:32 other concepts around them no that's great that's fantastic uh so that was uh the last one we covered was uh what letter was that that was a cardio yeah the others are pretty simple i mean i think defer diet we've talked about quite a bit already i'm sure you've had other folks on board too that have talked about the importance of a really nutrient dense diet coming back to my beta cell battery life this is where intermittent fasting and those types of practices are really important to preserve beta cells. So again, I'm seeing patients in a lot of stress. And I'm not going to be so stringent and say that you can't binge eat or have like this meal out on Saturdays. I'm like, okay, prepare yourself for the fact that you might have these meals that are going to be a high carb load to the body,

Starting point is 00:51:13 but then give those beta cells a rest period of 24 to 48 hours where you're not fasting necessarily, but you're keeping that carb load low, so we're not burning out that beta cell battery. So dietary strategies are obviously key. And then to sort of round this up, the S is really stress and sleep. And we can talk more and more about that. Sleep is a huge one, and I'm sure you've had experts on the show to talk about sleep, powerful connection with immunity. And stress, I want to riff on stress for one other thing for my scientific audience out there that still doesn't bind to this concept. There was an incredible study done that actually took individuals and they had them fill out

Starting point is 00:51:47 questionnaires to see how they would actually react to stressful situations. And they basically grouped them into two categories. People that actually suppressed their emotions and they had a hard time dealing. and others that were just natural reframers. We talked about the importance of reframing. So they broke the groups into these two categories, and then what they did, Drew, was exposed him to cold virus, to rhinovirus,

Starting point is 00:52:09 and they measured the amount of cytokines in their nose. And just like COVID-19 and other viruses, they start in the nose and they move forward from there, and they found unanimously that individuals that were more emotional internalizers, they produced dramatically more IL-6, interleukin-6 cytokins in the nose. So that's some direct evidence that those of us sort of reframeers and have a healthier

Starting point is 00:52:31 approach to this that's not as emotional. We actually dampen down that cytokine production. So pretty fascinating study. It's so powerful because I think the leverage point off of that is finding this equilibrium where you also are protective. You know, our mind can be easily swayed. And if we're paying attention to too much media or even if that also includes social media and all the debates and the hot sort of back and forths that go on there,

Starting point is 00:52:57 that can pull you in one direction or another and immediately start to hit you down this downward spiral where you have been convinced into the idea of some form of tribalism, right? It's us versus them, some form of gloom and doom, right? Like, why bother? You know, it's all going to shit anyway. And I think that that's a very toxic mentality. So the more that we can be protective of our attention and our awareness and surround herself with good and uplifting people and conversations. And that doesn't mean that we can't talk

Starting point is 00:53:33 about the hotly debated topics. It just means that when you do it with somebody that you know or that you love, even if you guys have difference of opinions, there's a gentleness that relates and resonates throughout your body instead of the constant tapping into the news media for how to feel about a particular subject. You know, one example I want to bring up is there's certain terms that are out there that cause a lot of anxiety for us. And I think the top three list is the word mutation, right? So when you hear of mutant or mutation, I mean, this is like, this is a genetic term, right? It's change or genetic transformation to cause adaptations. But because of Hollywood and the media, we think of mutants and mutations as causing

Starting point is 00:54:15 death and destruction, right? But one thing I tell people is just remember when these viruses and bugs have been mutating for millennia, and this is something that naturally happens. But the good news is, guess what? We as human beings, we can mutate also, and we do mutate. We change our genetic material based on the food that we're eating, the exercises that we do. You've done some brilliant podcast when individuals that talk about the signs of epigenetics, right? So one of our goals is to mutate along with this virus and ahead of this virus. So all the things we talk about, we can be resilient and not, you know, really succumb to this. But again, it's my approach of reframing these very emotional words and make them as scientific as possible. So then it's really

Starting point is 00:54:55 more proactive. It's more plan-based rather than emotion-based. Plan-based and you know, plan-based and proactive really seems to be what we're missing out on. I think another reason that we're missing out on it as a society is that as we've gone towards a more compassionate languaging in society, right? And there's been a lot of pros of that. There's been some aspects of what people might call a little bit of political correctness, right? There's always going to be, you know, different aspects of it. There is this fear that I see in the medical community that if we don't accept people for who they are and what they are right now, which, by the way, you can accept anybody for who they are and what they are right now and still

Starting point is 00:55:44 give them recommendations on how to improve their life and be happier. But the fear is, in especially media that if you say anything related to somebody's physical health that you are in a way not honoring who that person is. And I think that that's just something to notice and pay attention to because that creates a lot of fears. Even one of my friends, a doctor in Austin on the front lines of COVID patients over there. And in the early part of the pandemic, we were having some DMs back and forth. And she was saying, you know, look, I'll be honest with you.

Starting point is 00:56:24 A lot of doctors are afraid to even get into the topic of health improvement because of, especially young doctors, out of this fear that somehow you are not honoring or you're not into body positivity or any of the other conversations that might be there. And I think that there's a beautiful and nuanced way to do that where you can accept somebody for who they are, and you can also support them. In fact, I would add in, you know, I know you're going to be on my business partner, Dr. Mark Hyman's podcast, you know, a big part of his last book, Food Fix was accepting, you know, in Los Angeles where I'm at, where we have a huge percentage of the COVID debts, unfortunately, is the Latin American population that's over here. And

Starting point is 00:57:10 there's a whole host of reasons why, including that, you know, the metabolic health of that population said. You know, one thing is, we would never go to that population. I mean, some people are, but it wouldn't be really getting to the truth and saying, why can't you, you know, as a whole, lose weight? Why can't you do this? We would never approach shame as an opportunity to try to bully people into that. We have to look at it and say, well, when you have, not everyone, but at the most vulnerable level, you have people that are working multiple jobs. When you have a situation where people don't have an income or live in food. deserts. There's so many factors that play into why people make the decisions that they do.

Starting point is 00:57:53 And when you meet them at where there are, you talk about all those factors, including getting to the root cause of how to help them live a healthier lifestyle. So key. And, you know, I think the real approach for me, and I think for a lot of us health leaders and practitioners, is often we might create an image of just being completely impervious to all the challenges that our own patients face. But you know as well as I do that many of our physicians are struggling with their own metabolic health as well. I have a lot of patients in my clinic that are cardiologists, endocrinologists, primary care

Starting point is 00:58:25 doctors. So when I see patients, often they've read my book, they look by my work, they think I'm leading a pristine lifestyle. But I tell them I struggle still with carb cravings. As much as I talk about emotions, you know, there are days that I can't meditate. I feel overwhelmed. And this is something I have to do on a daily basis. And I think as health leaders and practitioners, we have to be raw, transparent.

Starting point is 00:58:43 and open about challenges we face because otherwise we feel our patients feel very disconnected from us, you know? So I think that's really something key. Like you said, meet patients where they're at. We do that by being as open and honest about orange struggles. I think COVID-19, the pandemic, gives us a lot of opportunities to do that in this environment. Let's come back to the topic of metabolic health. And let's make it practical. You know, when you, since our last conversation, you've been on a bunch of podcasts, you've been chatting about this topic. You've been continuing to see, you know, patients individually and in group and corporate settings. What do you find is one of the hardest challenges that people have when it comes to getting started on improving their numbers?

Starting point is 00:59:29 Is it that they don't even know that they have poor metabolic health? Is it that they don't have the sense of how they're living, their lifestyle, their sleep, their exercise actually is having a direct impact? Like, what is the hardest thing when it comes to getting started? Yeah, I mean, right now it's a, this was a traditional problem, but I think time management is a huge issue right now because individuals, especially here in Silicon Valley, are just working around the clock. You know, before at least they had natural breaks in their schedule where they were going to the gym or maybe they were going to their child's soccer practice and maybe walking or getting outdoors. But now they have to be very deliberate in terms of setting those boundaries. But the only time they'll set that boundary, if they truly believe that they're doing something for their body that's going to have some sort of. of outcome that's meaningful. And like we talked about before, for a lot of individuals, it's so

Starting point is 01:00:18 weight focused that if they don't lose a certain amount of weight, they feel like their metabolic health cannot be improved. So that's why we really have to look at other measurements. Again, numbers like triglystoride, glucose, those are things you can change very quickly just by making simple dietary changes, but also subjective sensations, fatigue, energy levels, how are those doing? And then like we talked about, obviously, a little bit of aerobic improvement through sort of increasing that activity, level. But the key thing is I know ABCDs is quite a bit. We as practitioners have to just identify the one thing that's worth working on the most. So if it looks like everything's disrupted in this situation, I lately have been really focusing a little bit more just on the activity and the

Starting point is 01:00:58 exercise spectrum because that does so much to lift up our moods as well too. Obviously, diet does that as well too, but a lot of my patients are really struggling with their diet during COVID-19. So I want them to get, I want them to feel better, get that aerobic improvement, with that mood elevation and now all of a sudden they're ready to take on diet. In other patients, we might find that diet is the lowest hanging fruit because their metabolism is so disrupted, they can't produce energy. So they can't get their body to move. So between activity, cardio, and diet, those are the areas that we can pivot in.

Starting point is 01:01:28 But we need measurable outcomes to keep people motivated. So this is where things like continuous glucose monitors, sensors are really big things that we're looking at. You know, Fitbit, RRRings, they're looking at early markers based on resting heart rate, respiratory rate, temperature patterns, heart rate variability. So we're going to have some really powerful data already is starting to emerge, but a year or two years from now, a lot of the questions that we're sort of hypothesizing now, we're going to have data to show what are those markers, you know, the pre markers, right?

Starting point is 01:01:57 Not waiting for the A1Cs to go out haywire, not waiting for that placiform, but really intervening much earlier in the process. Can you give a cheat sheet? You've already mentioned a bunch of different labs, but for some folks, they're like, do I go and get one test for metabolic health. Do I go, you know, a bunch of them? Can you give a cheat sheet? When you're talking to patients about, you know, core metabolic health and all the things

Starting point is 01:02:20 that we've been chatting about here, what is the standard lab workup, at least, in addition to, you know, things that are not on the lab, your conversations with them, but if they wanted to go down this pathway, what are the standard labs that they're asking for to make sure that they have gotten done if it's not already being included in their yearly physical, which not every of those labs that I know you recommend are always included. Yeah, so I don't run a concert practice. I'm in a traditional practice where I see insured patients. So I'm very rigorous about sort of providing the labs that provide the most value.

Starting point is 01:02:53 So at a baseline, it is your standard lipid panel, your fasting blood sugar, your A1C level. I like to check liver function tests, especially that transaminases the AST and ALT, because often that's a preceding symptom, too. if we're seeing early signs of borderline inflammation, the liver, that can be an early marker of some insulin resistance flags. So I start with that. If we can get an advanced lipid panel where we can measure particle numbers great, but quite frankly, as an initial screen, getting a standard lipid panel is fine. If we end up seeing high triglystorides and LDL patterns that might be a little bit divergent, then we might get an advanced lipid panel. But I would actually

Starting point is 01:03:31 start with those numbers and sort of go from there. Now, in patients who already might have some history of pre-diabetes, diabetes, heart disease risks. Another lab I add to that is a highly sensitive CERactive protein. That's a good baseline marker for inflammation that's more specific to the vascular to the blood system. And many of my patients that have had baseline Ceracted proteins done before, we've, you know, again, said with COVID-19, we've seen fluctuations in those numbers. So it's kind of nice sometimes to have that as a baseline and sort of track that,

Starting point is 01:04:01 especially through the pandemic. But that's kind of my starting point for most of those labs. And then like I said, if they are wearing devices and heart rate things, I'm really like an old school PE teacher. I'm trying to assess what is your level of baseline cardiovascular function based on a one mile walk test, a job test, whatever we can get. That's a key metric I'm adding to that list as well. I want to return back to the topic of vaccinations because it's very topical right now. It seems to be the more that I went down the conversation of metabolic health, you know, let's say there's folks that are out. there that have their own viewpoint for a whole host of reasons that they don't want to get the,

Starting point is 01:04:41 you know, vaccine. One of the things that I, that I started to see, especially amongst the epidemiologist and, and really interesting thinkers who I feel like are bringing fair criticism on how the pandemic's been managed, fair criticism on how maybe there's been, you know, overfocus on just vaccines and not some of the other things that people can do, you know, a lot of things that I think are fair criticisms to add in. One of the things that I was really getting clear from them is that in a way, if you have poor metabolic health, that really is the population that would benefit the most from the vaccine because you're most susceptible to COVID. Am I right in that understanding? Exactly right. Because again, so when I've talked to individuals that are grappling with the

Starting point is 01:05:26 decision around the vaccine, and again, I'm basing this pre-lawn science, when we talk about this condition of insulin resistance, right? Coming back to that beta cell battery that we talked about, I mean, literally, if you are getting a vaccine, you were significantly blunting the antibody and the cytokine response when you're exposed to that. So you're protecting those key vital organs. So the ones that are most vulnerable, they need to protect whatever beta cell volume they have left, whatever lung reserve and things that they have left. So I think exactly right, in those vulnerable populations, the vaccine has significantly more benefit. So it is really key for them. And on the flip side, you know, and you tell me if this is a question you want to, you know, answer and you can obviously not answer too.

Starting point is 01:06:08 I have friends of mine, right? I have friends from all different walks of life who were individuals who got COVID, you know, they are in largely, you know, good metabolic help, but you could still get COVID, right? anybody can still get COVID. It wasn't, it was more like, you know, a flu, flu type thing for them. They were able to kind of mostly breeze through it. And again, for a whole host of reasons, and, you know, these are not people that are uneducated. You know, in fact, they actually go pretty deep into the science.

Starting point is 01:06:41 They've shared with me that they chose not to get the vaccine. And they had COVID. And especially looking out at, you know, natural immunity is a little bit more recognized in Europe. If you can prove that you had COVID and have a doctor's note that you recovered from COVID, that is one of the things that would allow for one of their, you to qualify for a vaccine passport or other things like that. There was another big study that came out.

Starting point is 01:07:07 It's a pre-print. So we'll see what, you know, it happens when it's a peer review. But it just came out yesterday. Former CDC director, sorry, CDC officer that I follow on Twitter, shared it with me, actually initially and showing that folks that had. COVID had up to 15 to 20 times, 27 times more protection than just the vaccine alone. Again, this is all new data. We need to see how this parses out around the world.

Starting point is 01:07:36 But anyways, what I'm getting to is that there's a bucket of people that are, I know, that have had COVID that also feel like they are in good metabolic health and feel that they don't want to get the vaccine. If that was somebody who was, you know, your patient, you know, how would you feel about that? Do you feel like, you know what? That's their right. And that's okay. And even if natural immunity is not fully recognized here, it's recognized in many other parts

Starting point is 01:08:02 of the world. So, you know, I'm okay with it or, you know, it's a very nuanced thing. But I thought I'd just ask you since I have you here. Right, right. Yeah. You saved the most, the trickiest one for last for sure. But absolutely, I mean, I approached it the same way that I would with somebody who's grappling with, you know, getting the vaccine and doesn't have natural immunity is I tell them

Starting point is 01:08:21 whatever I know based on the science, the pros and cons. One of my thoughts is that we know this is a virus, it's constantly mutating. And, you know, the vaccine is very specific, you know, is very specific to that spike protein. So, you know, having the vaccine in hand looks like, you know, with Delta at least, we've got great vaccine protection for future mutants that might provide that as well, too. So that's one thing is providing protection against maybe future variants. But the other thing, too, is, you know, there are mixed studies. You brought up the fact that natural immunity might have a more robust response, but there's also other studies that show that the vaccine itself might actually cause less of that antibody, I'm sorry, less of the viral particle replication, and it might dampen

Starting point is 01:09:04 some of that cytokine response. So there's a lot of gray areas with this right now. I'm still leading with the science on the vaccine side. But, you know, again, I'm going to present whatever emerging is out there to compare natural immunity. And right now I'm leaving the decision to patients. But I would say that I don't want them to be reckless in the sense of if they have high-risk family members and things, I wouldn't naturally equate their natural immunity with necessarily getting vaccine. I'd so want them to get the precautions until we have some firmer evidence around that. Yeah, it's a great point. Things are always evolving. And I would also say that I think the same is true for folks that are, you know, vaccinated. It was earlier in the year that the CDC announced,

Starting point is 01:09:42 I believe it was May 2020, 2021, sorry, 2021, that they were no longer tracking breakthrough infections unless they were ended up in a hospitalization and a more severe case. And it was actually an amateur data scientist. NPR had a great report about this who was looking at a lot of the labs and the data on people getting, you know, COVID cases. And he noticed this individual was from the LGBTQ community and he's an amateur data scientist and he saw this uptick that was happening in Massachusetts. And he put a call out on Twitter to a lot of folks that are in that same community and said, listen, I want to really encourage you

Starting point is 01:10:21 that if you, even if you didn't get really sick and end up in the hospital, I want to encourage you that even if you are vaccinated, I want you to go get a COVID test because there seemed to be something that's happening. And his data that he collected and then sent to a friend that was at the CDC was a big part of the push that had the CDC recognized that breakthrough infections are a lot more common than they were recognizing. And what I love about that is just the fact that, you know, it's always evolving, you know, hats off to this citizen, you know, scientist for putting it into the ring. And we also are trying to make sure that vaccinate or not, you know, underlining mechanism

Starting point is 01:11:06 that's super important to pay attention to is metabolic health because, you know, a couple of sleepless nights, a little bit of drinking, you know, that, like you can get COVID just in a second even if you are vaccinated. Right, right. And I've seen some individuals, even in my own circles. Once they got vaccinated, they felt like it was a passport to act like there's no pandemic out there. A lot of reckless behavior, we have to be very conscious and methodical with their behavior,

Starting point is 01:11:33 whether we're vaccinated or not. And as you know, even with the vaccine, there's still significant viral lows reported in the nasofarangs. There's still transmissibility. So we have to still take similar precautions even if we're vaccinated. So, yeah, I mean, hats off again to that citizen scientist. We've really got to stay cautious whether we're vaccinated or not. What's your vision and hope as we move forward from here?

Starting point is 01:11:56 And we're looking out into the future. And everybody's trying to make sense of where the world is going. What's your vision and hope that happens, especially in the context, of this empowering information of metabolic health and really how, you know, this virus is going to continue to mutate and be something that the world seems to be is just going to continue to deal with. Well, I would say the one positive, or there's maybe a couple of positives, but the one thing is I think overall the public has become much more savvy and informed about science, about

Starting point is 01:12:33 terms like immunity and cytokines, metabolic health as a result of the pandemic, because of podcasts like you, Dr. Hyman, and others who've really gotten the word out to so many, I think people are starting to take this a little bit more seriously. I've clearly had patients that I've been seen for years. And, you know, I've been talking about diabetes and heart disease for a long time. But COVID-19 is something that they feel immediately. They've had relatives in India, let's say, that have actually experienced this. It's, you know, again, I don't like to use scare tactics in the office, but the writing's on the wall that this is something that I can't. can't wait five to 10 years on. This is something that you need to, you know, learn about

Starting point is 01:13:07 and act on more immediately. So I think you brought up a key point is we have to really get around the public health messaging. We need to tie the COVID-19 in a very empathetic way and really provide goals and metrics that common people from all walks of life can stick to, getting more physical activity, simple changes in the diet. But I hope this can be a bit of a push and a motivator for people to really prioritize that metabolic health and themselves and their kids as well too, because that's something we've been trying to do for a long time. But I think I am starting to see people pay a little bit more attention to their metabolic health as a result of this. Are you seeing that even more practitioners themselves are coming to you and some of the

Starting point is 01:13:45 resources you have for getting themselves more educated so that they can have better conversations and support patients? Yes. I've had a lot of practitioners come to me to benefit from the information because unfortunately a lot of information is not part of traditional medical training, but also to be able to relay that out. And that is one of my incentives is to create content that a lot of our practitioners can use because they're seeing high volumes of patients. They don't have the time to spend 30, 40, 60 minutes with an individual to do all the things necessary to motivate them and come up with a metabolic plan. So that's why they lean on some of my resources and a lot of our great colleagues out there in the healthcare space to really point them in that direction.

Starting point is 01:14:22 And that's been the beautiful thing about this community is I teach a lot of my colleagues is how to prescribe podcasts, right? Podcasts and tools and health education sites out there, books that are out there so our patients can become more informed. And I think that's one of the most important things we can do as doctors is be resource navigators for our patients. On the topic of a podcast, you launched your own. Congratulations.

Starting point is 01:14:44 Very exciting. I was listening to one of your episodes. Thank you. You were one of the motivators too. Tell our community about it and what the focal point is going to be. It's really the focus. And I love the fact that podcasts have really elevated the overall scientific IQ of common listeners out there. But I do find that sometimes there's very complicated topics. You know, a lot of the things that we talk about around insulin resistance and mitochondria,

Starting point is 01:15:10 and I love to teach. So I wanted to make sure if I added a podcast, it would be something that's a little bit different. So I use a lot of imagery and a lot of nymonics in creative techniques to get people to understand topics like insulin resistance, autophagy, longevity science, all the stuff. So it's a bit of an experiment, but I'm having a lot of fun, bringing those concepts to the podcast so people can really dig deeper. Because I find the deeper people learn about science, the more deep their motivation is around what they're doing to their body. So that's one of my missions out there. So I hope the podcast can be a vehicle to help me achieve that. I think along with that is that even if you weren't outside of, let's say, high school,

Starting point is 01:15:50 classically trained in sort of the sciences, you know, you don't have a master's science or or doctorate or PhD, there is a beauty to when somebody can use storytelling and analogy and you do this so well that you get the framework. You can get the framework without being an expert in the science. And if you get the framework, you can figure out how to apply to your own life, no different than you don't have to be the world's,

Starting point is 01:16:13 you know, best basketball player to be an effective coach that is there for a basketball team. You have to understand certain things, but you, you know, it's not exactly, you have to be in the weeds and understand every single component. But the question is always, what are the frameworks to understand that can help you improve your life? And I think that the framework that you've helped built and educate people around metabolic health

Starting point is 01:16:37 has been one of those things because now it's, we're less focused. This is why I'm such a so passionate about things like CGMs where the conversation previously was, what's the right diet? Should we be vegan, vegetarian? Should we eat this? Should we eat that? It's like you can do everything. anything healthy and you can do anything unhealthy. So within the context of that, let's look at

Starting point is 01:16:58 actually the things that really lead towards health and the things that don't. Is there an analogy or something that you explained recently on a podcast episode that you might want to share here with our audience that could be semi-related to this conversation? So I actually used one of them already and tested it out on you, which is really the beta cell battery. So that's one of them. And then, you know, I use a lot of roadway and car type of analogies. And we actually talked about the glucose car. So I did try. out some of my best material on you guys. But then I do use models like mangoes to explain how cells, nuclei, and cytoplasms work. So I'm going to keep throwing things out there. And I might

Starting point is 01:17:33 eventually add some sound effects as well to make it as memorable as possible. Because as you know, Drew, our ancestors learned so much by storytelling, right? They didn't have Google. It was volumes and volumes of information that they ingested through really creative storytelling. And one of the things I'm trying to do is get people off screens a lot more. So if they can imagine it with their own mind and really retain that information, I'm hoping that's going to be a lot. powerful tool for him. Well, in preparation of this interview, I heard you use an analogy that was based on the song, Watermelon Sugar High. Oh, gosh. In an interview that you were doing, and I thought, man, you know, now, anytime I hear that song, I'm going to think of you,

Starting point is 01:18:13 and I'm going to think about that analogy. There we go. Nice. Yeah, I do bear a striking resemblance to the singer, so absolutely. Dr. Ron, this has been fantastic. Any final words that you want to leave our audience with or places that you want to send them related to this conversation, you know, that's continuing to evolve around COVID-19 and metabolic health. Yeah, no, I think we covered the big topics here. And like I said, there are so many very small, simple changes that we can make that can have game-changing improvements on metabolic health. It's not about running marathons and doing all the crazy things that sometimes that are out in the media that we feel like we have to do to improve our health. So setting these simple goals can be really powerful. I've got a lot of resources

Starting point is 01:18:54 on COVID-19 at my blog. So if you check that out, there's a free COVID resource guide that you can tap into too. But really, I wish everyone the best, hope we keep focusing on metabolic health. And, you know, let's get through this thing together. Beautiful reminder. Thank you for coming back on the podcast and sharing your wisdom. We'll link to your own podcast that's out there. Congratulations again.

Starting point is 01:19:16 And some of the resources that you mentioned. Dr. Sina, I really appreciate you. And thank you again for coming back. Thank you so much. Take care.

Dhru Purohit Show - #236: How Poor Metabolic Health Allows Covid-19 to Hijack Our System with Dr. Ronesh Sinha

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