Feel Better, Live More with Dr Rangan Chatterjee - #206 How To Optimize Your Immune System & Fight Viruses with Dr Roger Seheult

Episode Date: October 5, 2021

This week’s episode is all about the immune system and my guest is Dr Roger Seheult. He is a California based medical doctor, who practises as a critical care doctor also specialising in pulmonology and sleep.    Although you might expect an intensive care doctor to be concerned only with emergency medicine and quick fixes, Dr Seheult is really passionate about prevention. And when it comes to understanding inflammation and immunity, I can’t think of a better person to explain the science. Whether you’re worried about coronavirus, you want to avoid other winter bugs, or your goal is fending off chronic disease, I think you will find this conversation really useful.   We begin by discussing the link between inflammation and immunity. We speak in depth about the link between low vitamin D levels and coronavirus, how it might be used as both preventive and treatment, and exactly how much we should all be taking. Vitamin D is produced on exposure to sunlight, which leads us to talk about the importance of light – and dark – at the right times, for our circadian rhythms. This of course impacts on sleep and what Roger has to say about its vital role in immunity might just persuade any night owls out there to turn in early tonight.   From hot and cold therapies to nutritional supplements, food to forest bathing, stress-relief to spirituality, there’s so much useful stuff here. I hope you enjoy this conversation and can use it as a toolkit for feeling your best as we head into the colder months. Thanks to our sponsors: https://www.zendium.com/livemore https://www.blublox.com/livemore http://www.athleticgreens.com/livemore Show notes available at https://drchatterjee.com/206 Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/3oAKmxi. For other podcast platforms go to https://fblm.supercast.com. Follow me on https://www.instagram.com/drchatterjee Follow me on https://www.facebook.com/DrChatterjee Follow me on https://twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

The beauty is you don't need a test, you don't need a doctor, you don't need a pharmacist to initiate this. Sometimes the most helpful remedies for the human condition are not packaged in a pillbox. They're actually packaged in nature. Hi, my name is Rangan Chatterjee. Welcome to Feel Better Live More. Welcome to Feel Better Live More. some of my posts about it. Many of you have been in touch to ask me to cover my experience and my learnings on the podcast. I do plan to do this in the coming weeks for sure, once I have the right guest in front of me. Now this week's conversation is all about the immune system and my guest is Dr. Roger Schwelt. Dr. Schwelt is a California-based medical doctor who is quadruple board certified in internal medicine, pulmonary

diseases, critical care medicine, and sleep medicine. He's the co-founder of MedCram, a medical education company, where his mission is to demystify medical concepts. And really, Roger's ability to do this is one of the main reasons I invited him onto my show. As we move into autumn and the colder months of the year, certainly here in the UK and the US, I really wanted to have a conversation about what we can all do to improve the health of our immune systems. And this really is an area where Dr. Schwelt has a high degree of expertise. Now you might expect an intensive care doctor to be mainly concerned with emergency

medicine and quick fixes, but on the contrary, Dr. Schwelt is actually really, really passionate about prevention. We cover so many different topics today that I really think you're going to find incredibly interesting. We talk about the link between inflammation and immunity, the relationship between low vitamin D levels and coronavirus, including how vitamin D can be used for prevention as well as treatment. We talk about natural light and how exposure to it at the correct times can profoundly influence our natural circadian rhythms. We also talk about sleep's effects on our immune system as well as which parts of the sleep cycle are most important. We also cover

hot and cold therapies, nutritional supplements, food, forest bathing, stress relief, and spirituality. This really is an episode jam-packed full of practical information for you and your family. I really hope you enjoy listening. Now, my conversation with Dr. Roger Schwelt. So you are quadruple board certified. You work in the intensive care unit seeing patients who are incredibly sick. You're also super passionate about prevention. What are the sort of things that we can all do to reduce the likelihood that we're going to get sick in the first place? Yeah, so the immune system is a wonderful, wonderful part of our body.

But it's also interactive. And a lot of the way your immune system works is through inflammation. There was a study recently that looked at this and they equated that about 50% of all the deaths that have occurred in the United States, at least, are due to inflammation. If you think about it, it's actually quite astounding. Heart disease is an inflammatory disease. Cancer can be attributed to inflammation. All of those other conditions that we talk about are related to inflammation. Sleep affects inflammation. The immune system uses inflammation. So I think when you talk about the immune system, you almost have to step back and look at what is going on and the effects of inflammation.

And that ties into stress. It ties into just well-being. It's a huge subject. Yeah. Given how much fear there is at the moment in the general public, I guess all over the world, whether it's here in the UK, with you in America, or sort of further afield, a lot of people are scared of getting ill, especially coming into autumn and winter, of getting taken down by viruses. And so, I guess, are there specific things we can do to support our immune system to help reduce the likelihood of coming down with viruses? So I guess vitamin D, I know you've done a lot of work on this, might be a really good place to start because it's something really practical that we can each do for ourselves, can't we? Right. So before we get into any specifics of vitamin D, let me tell you what my philosophy is. And it's called the Swiss cheese

model. So before anyone gets started on that, you know, sometimes when you talk about one aspect of what you can do to prevent, people will get this assumption that you don't need to do anything else. And I am certainly not in that camp. I'm definitely a Swiss cheese model. So what is a Swiss cheese model? So anytime you cut a piece of Swiss cheese and you look at the different pieces, you'll see that the holes are in different parts of the cheese. And if you were to imagine like bullets flying at you and the Swiss cheese could protect you somehow from those bullets, except for where the holes are. If you just put one layer of Swiss cheese on, you're going to miss. There's going to be bullets that go through. And the more layers you put on, the better protected you are.

So I am definitely in all of the above type things. So I don't want to get anyone misunderstanding that just because we're talking about vitamin D, that that's all you have to do and you don't have to do anything else. As we'll talk about, the more layers of protection you have, the better off you're going to be. Let's talk about vitamin D. If anybody in the world has led the science on vitamin D, it's got to be the British. It was in the British Medical Journal a couple of years ago that there was a huge meta-analysis that was published looking at 25 randomized controlled trials that showed that faithful daily or weekly supplementation with vitamin D reduced the incidence of acute chest infections.

There's a study group called TILDA, which is looking in Ireland, and they're showing a 50% reduction in acute chest infections. And this was all before COVID-19. So what's going on with vitamin D? Okay. So anyone above the 35th parallel, and that for those of you living in the United States, that's the southern border of Tennessee, that's pretty low. That's got to be somewhere like around somewhere in Spain. Anyone living above that 35th parallel isn't going to get enough sunlight in the winter season to keep up your vitamin D levels. And so supplementation with vitamin D is going to be a good idea. If you look and see when the viruses come in, when the flu virus comes in, when coronaviruses, non-COVID-19 coronaviruses

come in and respiratory syncytial virus, they have this seasonal effect where in the wintertime, we have them up in the northern hemisphere and then in the wintertime, we have them up in the northern hemisphere, and then in the southern hemisphere, we see them in July. And so why is that? Well, there's a number of reasons why that could be. There's humidity. There's a number of factors. But we believe that sunlight and direct sunlight with ultraviolet B radiation to the sun produces the vitamin D that we need to be able to modulate our immune systems.

So, if you look at vitamin D itself, just Google vitamin D, you'll see that the structure of vitamin D looks very similar to steroid hormones like cortisol, like aldosterone, like testosterone. These substances are shaped this way because they can go directly into the nucleus and actually cause transcription of DNA into its effector proteins and change the way cells behave. Now, this is really important when we talk about, for instance, COVID-19. Because in COVID-19, there is two parts of your immune system that you've got to understand. The first part of your immune system is the've got to understand. The first part of your immune system is the innate immune system. It starts off early. It's the thing that's responsible for taking care

of the virus in the first seven days of an infection. It goes around looking for things that are generally not supposed to be there and eats them up. So macrophages, natural killer cells, all of these things are the innate immune system. It's very strong when you're young. It gets weaker as you get older. Now, the second part of your immune system is the adaptive immune system. This is the part that is really causing a lot of the problems later on in COVID when after seven days, all of a sudden, the adaptive immune system wakes up. And this is the part that has antibodies, T-cells that attack cells where the virus is there. And because the virus has gotten into so many cells, particularly in the

lungs, when the adaptive immune system comes online, it starts to attack the lungs and that's what gets people into the hospital because the lungs become inflamed. They can't diffuse oxygen into the body. And it's this mismodulation of the immune system, some people believe, is the reason why people are having problems with COVID-19. And vitamin D is right in the center of that. Yeah, vitamin D is something that I guess we've known for years helps support our immune system health. And I really like what you said about this Swiss cheese model. I very much have that approach as well as a medical doctor, that the nature of science means that we look at one thing in the trial, right? We look at,

does this one thing make a difference? But then when you translate that to a patient, you think, well, there's multiple trials showing that, as we'll talk about today, vitamin D, sleep, stress, these all in isolation have been shown to help support the immune system. So why do we have to choose one instead of another? Why don't we do all of them? So I really appreciate you sharing that Swiss cheese model because I think it's something that we need more of in medicine, if I'm honest, particularly at the moment where, you know, you are on the front lines, you're seeing patients with a relatively new set of symptoms. I guess you have to take a common sense approach.

You can't wait for all the kind of data to be there as you might want. You have to actually go, well, it seems reasonable that vitamin d would help support this patient's immune system yeah exactly and and what's there to lose i mean vitamin d is is probably the most tolerable fat soluble vitamin there is um very there's very good studies that show that i mean out of thousands and thousands of patients the the risk of overdosing on vitamin D is pretty low. And so, when a patient comes in, what's the risk, right? So, that's what we do. We treat people. We make sure that they're vitamin D sufficient. And we go from there. The risks are really low and the benefits potentially are high. And I know there's a

big debate, not only in the United States, but also there in the UK, and around the world about, you know, what is the threshold for use of vitamin D, if we don't have direct randomized controlled evidence, but we have some case control study data and epidemiological data, that's pretty compelling. What's the risk really of treating with vitamin D? And I tend to agree i mean we're trying to save save lives so yeah i mean when it comes to vitamin d um you know i'm very passionate about it because when my my son was six months old he was super sick he had a hypocalcemic convulsion when we were on holiday in France, and that was secondary to vitamin D deficiency. So he had, you know, for many months, probably super low vitamin D. That then led to his serum calcium dropping, which led to a convulsion and us being, you know,

super, super scared that we might lose him. So that was really when I saw in a very extreme acute situation just how important this vitamin is. But since then, for 10, 11 years, I've been diving into the research and you can see associations at least between low vitamin D and all kinds of different conditions. So I personally have a very low threshold to recommend vitamin D to my patients, because as you say, I see the benefits potentially are profound, and the risks are very, very low. Yeah, exactly. The one risk, though, that we do is those people that don't see the Swiss cheese model. So if they think that just because they're supplementing with vitamin e they're going to be perfectly healthy uh remember that each slice of that swiss cheese has holes in it and so it's not where you stop that's where you start but

it's not where you stop what if we just think about vitamin d then for people listening or people watching and think okay i get it it's going to help me support my immune system. Do you have any specific dosing recommendations I think is important to talk about? But also, I know you're so good at articulating science in a very understandable way. I wonder if you would mind explaining how we typically would get vitamin D from sunlight, what would happen when it hits the skin? Because I think that's really interesting for people to understand that the sort of evolutionary context there. Yeah, so there's different types of ultraviolet radiation, there's ultraviolet

A and B. And A unfortunately can get through just about anything, glass as well, for the most part, and it causes all the sun damage that we don't like. Ultraviolet B though is really what we need to convert the cholesterol-based substances in our skin into vitamin D. So the base product is already there. It just needs to be converted using ultraviolet B. That unfortunately cannot penetrate through glass. So you really have to be outside with your skin exposed to the sun. And this happens very, very deep in

the skin. And so it's so deep, in fact, that people with darker skin with the melanin in it, well, it actually block that ultraviolet B to some degree. So what does that mean? People who are older are at higher risk for vitamin D deficiency, because they don't convert that as efficiently people who are darker skin living at higher latitudes are going to be more at risk for having vitamin D deficiency. And so that's important to understand. So in terms of the basic science, you're getting a cholesterol derivative that your body makes and you're converting it into vitamin D. So that's the base product. Now what happens is the liver and the kidney modify it into its active form, and then it's ready to do its job going into the cells. And we see vitamin

D receptors in not only in bone metabolism, but also in the white blood cells that are especially important in fighting off infections like COVID-19. Now in terms of dosing, the people that are most at risk for vitamin D deficiency, like we just talked about, the endocrinological societies recommend no more than 4,000 units, international units per day for supplementation. Now, I've seen people personally that have gone up to 10,000 units a day, and they've had their levels checked, and they were still within a reasonable range that we weren't concerned about toxicity. You can get 50,000 units tablets over the counter, and I wouldn't recommend going up that high. But so in terms of what's the highest dose, I would say around 4,000 international units. People do

far less than that. I think the recommendations from the governments are usually around 400 international units a day. The difference may be because we're talking apples and oranges. We have very good data, very good research that goes back decades about exactly how much vitamin D we need for good bone metabolism. But as you know, I mean, just because you need so much flour for one recipe doesn't mean you need exactly the same amount of flour for a different recipe. And what we're talking about here is not bone metabolism. We're talking about immune function. And there are some experts that believe that the levels that we need should be higher. So let's talk about levels for a

little bit. First of all, you have to be careful because there's two different scales that are measured. There's nanograms per milliliter and then there's nanomoles per deciliter. So you have to be careful about that. The nanograms per milliliter is usually in the 20 to 30 range. And that's 30 is kind of where you need to be for good bone metabolism. Some experts believe you ought to be closer to 50 or even 60. And that's interesting because there was a study in the United States that looked at the incidence of SARS-CoV-2 infection related to vitamin D levels. And they found that as vitamin D levels drop below 50, that's when we started to see an increase in SARS-CoV-2, regardless of where

they lived in the United States, in the north or in the south, regardless of whether or not they were dark-skinned, light-skinned, male or female. It seemed to cut across all those different groups. So, to review again, if you think you're at risk for vitamin D deficiency, spend a lot of time indoors, older, darker skin, high latitude, then supplementation with up to 4,000 international units a day probably would be beneficial, especially if you're not able to get a lot of sunlight and you're going through the winter months. Yeah, there's a couple of things there which I found really interesting. First of all, I agree with you. all, I agree with you. I think we have very conservative recommendations for vitamin D based upon, as you say, the kind of historical nature of study, which has typically been around bone health. And I remember, Dr. Schwell, maybe 10 years ago or so, I was working in a practice in Oldham in

the north of England. And there was some new vitamin D guidelines from the local health authority that as physicians, we were meant to be following. And 0 to 10 was regarded as deficient. Yes, you should be supplementing and replacing. 10 to 20, I can't remember the exact wording, was something like insufficient or suboptimal consider replacements and then 20 to 30 optimal no need for action which is really interesting because you know as you say we're now talking about potentially if you're under 50 potentially your immune system health is not as robust as it might otherwise be. So I think this really speaks to something else in medicine, which I feel we need to evolve

somewhat is rather than black and white, this is abnormal and this is normal. It's like, well, okay, but what about optimal? What is optimal for what we are looking for? So that was one point I wanted to just raise, which I found really interesting. But then I think the other point is, we say for those at risk of vitamin D deficiency, but as you say, some people who take even 4,000 units a day are still going to be low on their blood levels. And there's all kinds of factors why that might be. I know that there are some genetic variants with the VDR receptor that might make it more

difficult for those people to have adequate levels of vitamin D in their bloods. But many of us, we all work indoors these days, talking about the Northern Hemisphere. So as we have this conversation at the moment, it is September, you're in America, I'm in the UK. We're at the tail end of the summer. We are now coming into autumn and winter when actually we're more susceptible to these viruses. So you kind of feel, yes, I've got dark skin, right? So I'm going to be one of those people who needs much more sunlight to get the same level of vitamin D. But I guess we could start to make a case that yes, there's people at risk, but it's

also, it's not, it doesn't take a million, you know, it doesn't take so many steps on our head to go, well, there's a case potentially that all of us might benefit. Do you know what I mean? Yeah, absolutely. Absolutely. Totally. And that's where we are headed in medicine. We're headed to sort of specialized or medicine recommendations specialized to us individually based on our genetics, based on testing, based on all sorts of things. And this would be no exception. I think if someone is really concerned about the potential possibility that they have vitamin D deficiencies is get tested. Yeah. I mean, it's a very simple, cheap test to do. The supplementation is very cheap as well. So I think that's a really good

recommendation. Some people say that you don't need to supplement. You can get this sort of stuff from food. I'm not convinced that we can eat enough of the foods um that contain vitamin d to actually get those optimal levels but that's one thing i was hoping you might address the other thing is that on an evolutionary basis um some people say well we're meant to drop our vitamin d levels over the winter because we wouldn't have been outdoors much. So how does that shape your thinking somewhat if people make those arguments to you? Well, first of all, in terms of dietary, I think you'd have to eat a lot of mushrooms. I know fish and chips is very popular in the British Isles. You'd have to eat a lot of fish to get it. I think supplementation is probably the best thing to do. Along the lines of dietary though, I would make this point.

Here in the United States, we have this very poor, bad, fatal attraction to fructose corn syrup, high fructose corn syrup. It's sort of the sweetener of choice over here. Unfortunately, it's probably one of the worst that we can have. There's been a number of studies that have shown that high fructose corn syrup can inactivate vitamin D and its effects downstream. So even though you might have good levels, consuming a lot of high fructose corn syrup is not a good idea. And I would just ask, you know, if you pick up a can of Coke or Coca-Cola, it's going to be sweetened with high fructose corn syrup if it's purchased in the United States. Do you know what they, is it cane sugar? What do they use over there in Europe?

Yeah, I think it is. It's definitely not high fructose corn syrup over here. But I think what you're saying really speaks to, as you call it, this Swiss model approach, which is, you mentioned right at the start that the immune system uses inflammation as one of its tools to help us fight off whatever we're fighting. And you've mentioned vitamin D, but also now you're speaking to food, right? And where do we get high fructose corn syrup? It's typically in highly processed foods. So maybe we don't have high fructose corn syrup here as much in the UK and Europe, but we do have lots of highly processed foods that are potentially driving inflammation in our bodies and may also be having a similar role potentially.

Yeah, I would love to talk on that. But to get back to your second part of the question in terms of the evolutionary role of that, it's an interesting topic because the whole world is not under that same pressure. So if we go to the equator, you know, my father's family is from Trinidad. And so that's about as close to the equator as you can get. You just have a rainy season and a dry season, but the sun pretty much sets every day at six or seven o'clock. And that's very different, of course, when you're up in the Nordic countries in the far north. I've been thinking about this, and if there was a disadvantage for those people living at those high latitudes in terms of vitamin D, I find it very interesting that these same cultures that live at those very high extremes have found, I believe, ways of compensating for that vitamin D deficiency. And this is a whole other topic of discussion. But you notice that the cultures that, like,

for instance, the Swedes and especially the Finns, use a lot of this hot and cold sauna and bath type of things, which have been shown very clearly to be immuno-enhancing activities. You don't see that activity, of course, in cultures that are living at the equator. So, maybe more anthropological than evolutionary, but I think that it's interesting that these cultures that have lived there, I mean, for thousands and thousands of years, have come up with these ways of dealing with illnesses that they might get because of a said vitamin D deficiency. Yeah, I think that's really interesting to think about, isn't it? Of course, there are some cultures like the Inuits who eat huge amounts of fatty fish, which of course contains vitamin D. But then you also

think about the modern world and take someone like myself. My mum and dad came over to the UK from India. So my kind of heritage is to be in the Indian subcontinent where, you know, there's a very different levels of sunlight throughout the year. And so take me and my genetic heritage out of that background and put me in the north of England and you've got this mismatch, which potentially taking vitamin D might help me address. So it's super fascinating when you think about all these things. But again, I just want to make the point as you have that certainly here in the UK,

between May and September are the only months when we are getting the right frequency of sunlight to actually make vitamin D. That's a very short window. And even if you don't have the risk factors like dark skin, for example, very few of us are spending enough time outdoors to really get all the benefits, right? So I think this is a widespread problem. And I think the sort of last 18 months or so has really brought to the surface just how important vitamin D might be. Can I ask you, you know, there was lots of association studies with COVID-19 and many other conditions with vitamin D, but I heard you recently talk about the SHADE study in India. And I'm really interested as to vitamin D as prevention,

but also vitamin D as possible or one arm of possible treatment and how you think about that. Yeah, that's a very good discussion topic. I was just discussing this actually with a colleague of mine who's in Tennessee that was looking at this. So as I mentioned before, the liver and the kidney put on a couple of hydroxyl groups, some molecules onto this to activate it. And we feel that that active form is really what does the trick. The problem is, activate it and we feel that that active form is really what does the trick. The problem is that it takes about a week or so for these chemical reactions to occur in the body so that you could take vitamin D now but it's not going to become active for another week.

So that's a problem if you're having patients that are coming into the hospital. So now we're not talking about prevention, we're talking about treatment. And that active form can be prescribed over the counter or through prescription in a form called calcifediol. And there was a couple of studies that were done in Spain looking at the treatment because they wanted something quickly that they could use called calcifediol. That's the active form of vitamin D to see if it would work. And in those studies, it worked tremendous. I mean, the ICU admission rate in those COVID patients went from 50% to literally 1%. The problem was is that they weren't able to replicate some of those studies. There was another study that was

done in Barcelona. And so as it stands right now, we don't really have large randomized controlled trials looking at active vitamin D in these patients with COVID-19 to show an improvement. And so what we're left with is supplementing like what you mentioned in the shade study, where they took 60,000 international units of vitamin D, and they gave it daily for about a week. And what they found in that study, even though they gave these massive doses, is they found that inflammatory markers improved, which was a surrogate for infection. And they found that the time to testing negative on a SARS-CoV-2 test had improved in those patients that got those whopping doses of vitamin D. So interesting study, probably needs to be reproduced. There was

a similar study that was done in Brazil, where they gave a whopping 200,000 international units of vitamin D one time to these patients coming into the hospital. In that study, nothing changed. It was a negative study. So interesting interesting results not sure if vitamin d is ready for prime time in terms of preventing it but i'll tell you what in all of the patients that i am seeing in the hospital that are coming with covid19 we're putting them on vitamin d supplementation yeah and that speaks to what you're saying which is huge potential risk of benefit very low risk of harm right so we're talking about the immune system, we're talking about the things that we can all do to help reduce the likelihood that we're going to

get sick. Vitamin D is one of them. Before we leave vitamin D, there's a lot of talk about what we should be taking with vitamin D because there's, of course, lots of other nutrients that work together in harmony, for example, with bone health and actually vascular health as well. Vitamin K2 can be really important as well. Do you have any thoughts on how we take this supplement and whether we should be taking it alongside vitamin K2 as well? Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. Now, if you're looking for something at this time of year to kickstart your health, I'd highly recommend that you consider AG1. AG1 has been in my own life for over five years now. It's a science-driven daily health drink with over 70 essential nutrients to support your overall health. It contains vitamin C and

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they offer my listeners a one-year supply of vitamin D and K2 and five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs to 10. And these packs are perfect for keeping in your backpack, office, or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. That's drinkag1.com forward slash live more. vitamink2.com forward slash live more. Yeah, I think there's some data that shows that taking it with vitamin K2 is helpful in terms of vascular health. I think the key though, is if you're taking vitamin D and vitamin K,

both of which are fat soluble vitamins, that you take it with something that is fat soluble. That's going to help stimulate the appropriate mechanisms in your body, like your bile and the gallbladder to make sure that that gets absorbed. Because unless you're eating something that has some fatty food in it, it's not going to get well absorbed. Great. So let's park vitamin D for the moment. And then I wonder if we could move on to sleep. And the reason I want to go to sleep next is because we're talking about this evolutionary basis potentially of vitamin D. Light, sunlight is what gives us or has in the past given us most of our vitamin D levels in our body. And if we think about light, the other way our lives have changed dramatically is we've sort of flipped when we access light. We get probably not enough bright light in the days, and we probably get too much light in the evenings. And of course, this affects

our circadian rhythm, this affects our sleep. So when we're thinking about things that we can do to support our immune system health how important is sleep oh it's probably the most important thing that we can do in fact when we admit meg cram there's the uh is the uh the youtube channel and website that we publish on when this when coronavirus first came out and we didn't know how to treat this we had nothing um in fact the the the organizations were saying we don't know how to treat this. We had nothing. In fact, the organizations were saying, we don't know what to treat it with, but we know you shouldn't treat it with steroids. And what do we find out? And the UK recovery trial is that steroids work the best. What we were saying at the very beginning was, look, we don't, on MedCram, we were saying,

we don't know what to treat this with, but we definitely know that there are some things that we know improve your immune system. And sleep was the first thing that we talked about. It's so huge. There's so many aspects to sleep. There have been studies that have shown that if you don't get enough sleep, your antibody titers after a vaccine are not going to be high. We've shown there were studies that have been done where they took college students, which are our favorite subjects to use because they'll do anything. When you drop rhinovirus down their nostrils, that those that have had a better history of sleep in their past tend not to get infected with rhinovirus. We know that cortisol levels are connected to how much sleep you get. We know that slow wave sleep, which is usually in the beginning part of the night before 12 midnight, is connected to growth hormone. It's connected to

physical well-being, mental well-being. I mean, the list goes on and on and on about how sleep and melatonin. Melatonin is a huge anti-inflammatory medication. So just that by itself is an incredible tool to have melatonin in the body. So this is basically the bottom line when it comes to sleep. Go to bed early, get at least seven hours of sleep, and wake up in the morning and feel well-rested. That's really the bottom line with sleep. We can get into the details about why the first hours of sleep before midnight are so important. We can talk about slow-wave sleep and growth hormone, which is the essence of the fountain of youth. Growth hormone is secreted when you're young. It gets less as you get older.

We can talk about what's happening to society in general. what's happening to society in general. And we can talk about what it feels like when you say, I need to get my sleep and how that is negatively looked upon in society as weakness. We can talk about the people moving into the cities, traffic, having to get up earlier in the morning, and then getting home late at night. And our culture is to relax and watch television and kick back and eat big meals at night and go to bed late. I mean, there's so many things that we've done wrong in the last 100 years that impact sleep, and here we are. Yeah. Well, I want to talk about all those things because I'm incredibly fascinated with all those topics. But I guess that top line, again, is that the things that we can do,

if we take a few simple steps to try and improve our sleep health we can have a profound impact on our immune health but i guess it's a lot easier to pop a vitamin d supplement isn't it yes then actually have to proactively change our lifestyle so again swiss cheese model we're going to talk about doing multiple things the more of them we manage to do the the more robust our immune system health is going to be coming into the winter which is going to help prevent yes risk of viruses but also help reduce our risk of all kinds of other immune mediated inflammatory conditions whether that be heart disease um you know strokes whatever whatever it is you know having our immune system work better is always going to be a good thing.

So with sleep, let's start by talking about why it's the first hour or two, those hours before midnight, as you say, why are they so important? Because we've heard that for what, 50 years, 100 years, an hour before midnight is worth, is it worth two after? But you think, is there any science to this or is this just an old wives tale? No, it's absolutely, it's amazing. I was reading some writing from a health journal back in the 1800s. You're absolutely right. We've been seeing this for a hundred years. A writer by the name of Ellen G. White, she's on the top 100 Smithsonian influential Americans of all time. And she wrote that saying, she said, two hours before midnight is worth more than four hours after midnight. And of course, they had no idea what slow wave sleep was at the time. So here's the point.

Slow wave sleep is one of the stages of sleep that you get into early on in the night. As the night goes on and on, it gets less and less and less. What takes over is REM sleep. REM sleep is a completely different form of sleep. It's where you dream, you're paralyzed, your eyes move around. It's also helpful, but it's helpful in a different way. way. That slow-wave sleep that we see primarily towards the beginning of the night is coupled with growth hormone secretion. So this is the reason why that kids who get lots of sleep early on tend to get more growth hormone, and that helps with growth. It helps with physical restorative sleep, mental restorative sleep, and that's when you can get it. If you go to, is that that circadian rhythm, if your

brain and your eyes are subjected to light late into the evening, that is over time going to shift your circadian rhythm to tell you not to go to bed at 10 o'clock. It's going to tell you to go to bed at 12 o'clock. Or as some of you who are listening here in the audience, maybe you're night owls, you go to bed at one or two in the morning. You say, hey, look, I just can't go to bed before one or two. I'm not tired. That is because your circadian rhythm is somewhere over the Atlantic as opposed to being in UK time for those of you who are listening in the UK. What I mean to say is your circadian rhythm has shifted. The reason why it shifted is because you've exposed your eyes to bright light at 7, 8, 9, 10, 11, 12 at night, either watching television or looking at a laptop,

watching the news, turning the lights on. And so the way to get that back, there's two things that you need to do to get that back. So you're getting sleepy at 10 o'clock and you can actually go to bed and get the benefit of that sleep is number one, stop exposing your eyes to bright light at that late hour. Dim the lights, turn things down. You know, a lot of people tend to have this filter on their iPads that make it instead of blue light, it goes to red light. Well, there was just a study that was published a few months ago that showed that that's worthless. It doesn't work. It's better to published a few months ago that showed that that's worthless. It doesn't work. It's better to just turn the whole thing off.

So that's the first thing to do. The second thing to do is that when you get up in the morning is to expose your eyes to bright lights. And what that will do is it will start to advance your circadian rhythm. So instead of feeling sleepy at one or two in the morning, you're starting to feel sleepy at nine or 10 at night, and you're starting to come into that better sleep pattern. Yeah. It's always great to hear these things. I think many of us need to hear these things repeatedly. We hear them, we start implementing it, then we get back into bad habits. So it's always great to have reminders from

world-leading experts like yourself on just how important this is. So it's always great to have reminders from world-leading experts like yourself on just how important this is. But again, it speaks to light, right? The human animal has evolved around lots and lots of light and light at the right times. And we've kind of ironed out and sort of got rid of these natural rhythms. We spend too much time inside. We're stuck with these devices right in front of our eyes late at night. And what's interesting about that study, that the internal devices within the software and the programs may not be working so well, or as you put it, are worthless. I'll tell you one thing I've found useful with patients and myself are, I some uh i think it depends on which company you

buy from but i think there are some really good blue light blocking glasses that i know some people find incredibly helpful i know my wife when she first put them on maybe three years ago and she would at the time maybe look at screens in the evening and you know like many of us do, she popped them on and within 20 minutes she was just yawning. And what's incredible is it just shows how many of us actually have artificially pushed our circadian rhythm back. And actually, you know, a lot of us think that we're night owls. And I'm not saying none of us are at all, but I think many people who think they're night owls actually don't realize the impact that the artificial light is having on their circadian rhythms. You take a lot of these people camping, and you find actually, no, they fall asleep at half nine, 10 o'clock. But keep them at home, they can't fall asleep

until 1am. Yeah, exactly. It's important to have that cycle. That's a very important cycle, the circadian rhythm cycle, in terms of getting sleep so that you can be ready for the next day. I think a lot of people have heard these days about blue light at night, but less people have heard about the importance of natural light first thing in the morning. of natural light first thing in the morning. And is that something you're getting a lot of feedback on? You make all these incredible educational videos through MedCram. You're helping so many people. Do you get feedback from people that, oh, I kind of knew about blue light dot serve. I'm not doing it, but I knew about it. But I wasn't aware of how important natural light is first thing in the morning.

Yeah. There are some people that, uh, that relate to that, um, that haven't heard it, that haven't seen it, that they start to do it and then there's an improvement. Yeah. Uh, in my, in my first book, um, which came out a few years ago, which was in the UK, was called the four pillar plan. Um, one of my recommendations around natural light was like, look, yes, it's important to try and get and get 20 minutes of natural light first thing in the morning. And maybe if you have a morning cup of tea or coffee, get outside in the garden and drink your cup of tea or coffee in the garden. And I know when I go around the country here in the UK, many people come up to say, Doc, you know, for the last two, three years, I put my fleece on. I'm in the garden with my morning cup of coffee. So again, there may be someone listening to this

or watching who thinks, actually, well, I might start trying that because you're going to have your hot drink anyway, but why not have it and set your circadian rhythm up for immune health at the same time, right? Yeah. And that actually brings up a whole nother issue there as well, which is, you know, in science, we always try to reduce things to their lowest common denominator. So in other words, we've said here, and someone listening to this might think that the entire reason why we need to go out and have go into the sun is because of vitamin D. But but that's actually not the case. And you're not saying and I'm not saying I don't want anyone to think that there was actually a recent study that was done that showed that there was a reduction in COVID-19 mortality in people who went outside more, and they couldn't

relate it to vitamin D levels because the vitamin D levels that they were getting at this latitude could not have made a difference in terms of COVID-19. And we may know this because we know that there's a condition called SAD, S-A-D, Seasonal Affective Disorder, and it's obviously related to the amount of sunlight people are getting. And so there may be something more when you're recommending people go outside to drink their tea or coffee in the morning. Not only are they getting light from the sun, you know, they may not be getting enough vitamin D because it really needs to be overhead. The benefit they may be getting is something maybe outside of what we know is happening with vitamin D. I mean, there's fresh

air, there's ventilation, you hear the birds chirping. There was a recent study that showed that the more green that you see in your daily life, it improves your overall health. I mean, these are really interesting things that we're starting to find out that maybe we've moved from the outside to the inside. And maybe we didn't do as well as we could have done in terms of health and the body in that change. Given how important light is, and given that you are a practicing acute care physician, do you ever wonder whether in the intensive care units or in the wards that we could sort of upgrade the lighting? Because I know from working in hospitals, or I remember when my dad was really sick and I spent a lot of time in hospitals with him, you know, there's a bright fluorescent

lighting in the wards in the evening when patients should be sleeping. There's bright lights going on. It's noisy. You must see it. And I, of course, you know, things take time to change. But given how important light is, do you feel that hospitals need to do a better job of actually upgrading the light systems to help support people's health? Oh, let me tell you, it is so frustrating. These things are built like prisons. They've got these tiny windows and the lights are on. And I'll tell you, the night shift and the day shift come in and out of the intensive care unit. The patients don't know whether it's night or day. They get this thing called ICU psychosis because there's beeping and whistles going off at

all times. What we try to do now is we try to turn the lights down. We try to minimize interaction with the patients at night. We try to open up the blinds. So we try to work as best as we can with what we've been given, but we can't put windows where structural walls are. So in the new constructions, we're hoping that they're going to take this into consideration. I noticed, though, on television shows, the hospital rooms are these bright windows, huge rooms with windows everywhere. Unfortunately, that's not the case in the hospital that I work in. I want to talk more about sleep, but maybe we'll come back to that later this time, because I want to make sure that people who are tuning in know that there's

multiple things that they can do to sort of take control of their health and help, you know, improve their immune system health. We mentioned vitamin D, we mentioned sleep and how important it is to try and prioritize that. We touched a bit on food before, didn't we, around high fructose corn syrup. And I wonder if you might want to expand a little bit on foods and how that impacts our immune system. Yeah, so this is very controversial because, boy, you can't tell people what to eat or what not to eat. It's a very personal choice. I mean, let's face it, it's going into their body. So, I realize all of that, but let's look at some of the data. And this goes way back. I mean, they've been looking at diet and food and inflammation for a long time. There's actually

been kind of a standoff between the United States data and the European data for some point there. A lot of the U.S. data was looking at meat and vegetarian diet in terms of longevity. And there was a number of studies that have come out in the United States that showed that it didn't really matter whether it was processed or unprocessed meat, processed meat being like cold cut sausages, things of that nature. And red meat is just obviously the meat that you buy at the supermarket. All of those things seem to be associated with particularly red meat, particularly with inflammation and coronary disease, cardiovascular disease. study, a very large heterogeneous multi-nation study that looked at the same thing. But in their study, they found that that cardiovascular disease risk was only associated with processed meat, not so much unprocessed meat. Well, this went back and forth for a number of years. And it's interesting because the data now is seeming to go back, even the European data now. There was actually a huge UK biobank study that was published about six months ago that

showed, again, epidemiologically that both processed and unprocessed meats were associated with cardiovascular disease. And the question has always been why, why particularly red meat? I mean, it's not white meat. It's not fish. What is it about red meat that seems to increase inflammation, particularly in the vasculature and in the colon particularly, which is obviously where the food goes? And as of late, there has been some interesting advancements in the understanding of what's going on. And really, it boils down to something called

sialic acids. There's a group out of UC San Diego, University of California, San Diego, that's looking at this and also a number of other groups, particularly in France. What are sialic acids? So if you can imagine, you know, whenever you look at the proteins on the cells of surface, we've seen a lot of animations now because of coronavirus, they'll show you these spike proteins on the surface of the cell, but that's all they show you. They're actually not showing you everything. On top of those proteins are glycoproteins, and then on top of those are sialic acids, which are little sugar molecules. In fact, if you were to picture my arm, my arm would be like the protein, my hand would be the glycoproteins. And then on the very tips would be these sialic

acids. So what are sialic acids? They are sugar compounds. And as it turns out, humans only make one type of sialic acid. And I'm going to get a little bit nerdy, wonky here, but it's called NU5AC. NU5AC is the type of sialic acid that's produced only on human cells. Now, we have a gene in our body that used to produce NU5GC, but it's been irreparably damaged, and there's no human on the planet that makes NU5GC sialic acid. So, if you were to look at the surface of human cells, they would be completely covered with sialic acids of the NU5AC type. I'll just call that AC from now on. Now, if you look at animals, mammals particularly, so red meat, mammals, they make both AC and GC.

And so the problem is, is that when you consume, when humans consume animals that have NU5AC and NU5GC sialic acids on their surface and ingest it, it gets absorbed into the body. The body can't tell, the human body can't tell whether it's AC or GC. And they put GC onto the cell surface in the body. So to the immune system, which is not used to seeing AC, they see GC now and they see that as a foreign substance. There's been some great research out of France that have looked at this where they actually painstakingly asked everybody for their diet. They saw what kind of foods they ate. They went out, measured the GC content in those foods, and then went back to those same subjects and were able to measure anti-GC

antibodies. And they found a correlation with the diet that the more GC they ate, the higher the antibodies in their blood. And they felt that this caused a, what they call a cellitis or an inflammatory condition. And so they were able to connect these antibodies with the risk for colon cancer. And they believe this is also involved with inflammation in terms of coronary disease and cardiovascular disease. So it seems as though there may be a connection there. So when you're talking about immune system and diet, what you don't want to have when you're talking about COVID-19 is a hyper inflammatory condition, because it's just going to knock you into the hospital with BMI and cardiovascular disease. So that that's an interesting development that's just been published here in the last few months. And there's other things we could talk about, but that's one of those aspects that I

think are interesting. Yeah, I mean, it's super interesting. And as you were sort of discussing that, you were talking about how the science is moving on as it always does. And, you know, we look at these epidemiological studies, we try and make conclusions, then we look at more and it sort of seems to advance our understanding or potentially contradict what we had before. And I think it gets sometimes with diets incredibly confusing for the public to actually follow what they should be doing. Certainly my view, having looked at a lot of this science and actually for at least 10 years now, been actively helping my patients in a more chronic setting than yours, change their diets. The truth is I have found that if people stick to minimally processed

foods as much as possible, the truth is I've seen patients do super well on minimally processed foods as much as possible. The truth is I've seen patients do super well on minimally processed vegan diets. I've also seen patients do really well on minimally processed diets, which contain red meats and a lot of fish. And my clinical experience has led me, in conjunction with the research, to feel that it's that unprocessed nature of the food that seems to make the biggest impact that I can see. But also, I think you mentioned red meat, but I guess it's also what are you having in conjunction with that? Are you having lots of broccoli and kale and antioxidants and blueberries and raspberries, which is going to be different than if you're having that red meat with, you know, fries and, you know, highly processed breads. Do you know what I mean? It gets really

complex, doesn't it? And so how would you then summarize all that and give your patients a recommendation? Say, look, these are the things I feel you should be doing with your diet to help improve your health at the moment. Yeah, well, I mean, obviously, there's a lot of room for nuances in terms of the diet. I think we both agree that the processed foods are need to go, whether or not they're red meat or not red meat. There's plenty of processed foods that have nothing to do with meat that are probably not good for you. There was recently a study that was published, though, looking at this idea of red meat and carbohydrates. So I know a lot of physicians that want to be very healthy and they want to do healthy things and they choose to have high-protein, low-carbohydrate diets. So you've heard of the paleo diet and you've heard of, you know, Atkins, I guess, was the old term for it.

sort of, you know, the Atkins, I guess, was the old term for it. They recently looked at that in a study that was done in a network of physicians, about 3,000 physicians in France, Spain, Italy, Germany, UK, and the United States. These were physicians on the front line dealing with COVID. And this was a case control study where they looked at diet and they asked them, you know, here, what kind of diet do you ascribe to? Do you ascribe to a plant-based diet, a pescetarian, vegetarian type of diet, or a high-protein, low-carbohydrate? So, that's key there is the low-carbohydrate because obviously carbohydrates get sort of this wrap of being inflammatory. And what they found was in terms of COVID-19, after they adjusted for age, after they adjusted for the type of physician that they were in dealing with COVID-19 and

socioeconomic, all those sorts of things, of course, these were physicians, right? So there's not going to be a lot of difference there. They found that those that were on the high-protein, low-carbohydrate diet had almost four times the risk for moderate to severe COVID-19. That wasn't a causative study because it was case control, so it was an associative, but you've got to ask the question is what were they doing that made them four times at risk? And again, I go back in my mind at least to the risk of inflammation. you've got the SARS COVID-2 virus, it's attacking the ACE2 receptor, the ACE2 receptor is one of those things that converts angiotensin into, you know, angiotensin 2 into angiotensin 1-7. So in other words,

it's taking things that are very oxidative stress and turning it into reducing agents. And then when the virus binds the ACE2 receptor, it knocks it out. So now you have this oxidative stress test, essentially. And those people that are on the edge, you can imagine on the edge of a cliff, they've got diabetes, hypertension, high BMI. That's like a big wind blowing. Those people that are far away from the cliff's edge are not going to fall over. Those that are right on the edge because they've got diabetes, hypertension, they're going to fall over and those are the ones that end up in the hospital. So, I'm looking at this from an inflammatory standpoint. And if that's the case, you know, looking at the data, from my perspective,

I would say, yeah, definitely get away from processed foods no question about it and i would you know as the saying goes eat less food more plants yeah you mentioned the term oxidative stress uh could you explain what you mean by that for for some people who who may not be familiar with it yeah so oxidative stress is a term that is used in metabolism, that when there's a lot of metabolism going on in your body, there are chemicals that are produced that have electrons on them that need to be taken care of, and they could cause problems with other systems in your body. So we'll name some of them hydrogen peroxide, hydroxy radicals, superoxide. All of these things need to be dealt with. And the body actually has ways of dealing with it.

But the ways that it has of dealing with it uses up products. So for instance, glutathione is used in glutathione peroxidase which is a enzyme which reduces things You've heard of an acetyl cysteine, which is a supplement that you can get over-the-counter in most places That's a a product that can be used to reduce things or Antioxidize but but you can also find these things in in nature So anything any berry is going to have things packed full of antioxidants. These are things that reduce the oxidative stress of the body, which is important to have when you're talking about infections and immunity. So, raspberries, blueberries, boysenberries, gooseberries, strawberries, the list goes on and on. All of them are just packed full of these things. In fact,

the chemicals themselves, the antioxidants appear to be red and blue because of the way that they absorb light. And so these structures are just amazing. Beta carotene, carrots, blueberries. Anyway, all of these things reduce and reduce oxidative stress. Oxidative stress is bad because oxidative stress will cause inflammation. It damages DNA and it does really bad things to the body, can cause cancer and inflammation. Yeah, and just to tie it into what we've been talking about so far, yes, certain food choices, like all these berries, and I always double down on my berry consumption going into winter um that's going to help reduce oxidative stress but also vitamin d supplementation right also getting an enough good quality sleep those things as well help to reduce oxidation oxidative stress in the body and it's the body interconnected, right? It's not as if we

do that one thing and it just helps on this one arm. Again, it speaks to the Swiss cheese model that if you're sleeping more, you're eating more antioxidant rich foods, you're optimizing your vitamin D levels, actually you're going to bring oxidative stress down, aren't you? Yep, absolutely. Absolutely. his stress down aren't you yeah absolutely absolutely you mentioned n-acetylcysteine or nac for short um we're trying to talk about things that we can do to help support our immune system and there's some interesting data i think on nac and how it might be helpful at the moment so might be helpful for us to um you know reduce our risk of infection is nac something you knowAC something you've seen much of the research on? Is it something you take yourself or would recommend with your patients?

Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you

back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour, and I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision making and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long

term habits and improve our relationships. There are, of course, many different ways to journal. And as with most things, it's important that you find the method that works best for you. One method that you may want to consider is the one that I outline in the three question journal. In it, you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening.

Answering these questions will take you less than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel. Now, if you already have a journal or you don't actually want to buy a journal, that is completely fine. I go through in detail all of the questions within the three

question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal, or click on the link in your podcast app. I take anacetylcysteine, 600 milligrams twice a day, but I don't do it every day of the year. So I will do it during a winter season, again, for the same reasons that you point out. The reason why I do that is because there was a study. That's the reason why I do most things. There was a study that was done back in the 90s that looked at prospectively supplementation with N-acetylcysteine, 600 milligrams twice a day for about three months during a flu season in the United States. And what they looked at is not only the number of infections that occurred with the flu, but also the severity. So what they found

was that NAC had absolutely no impact on preventing you from getting the flu, which is what we would expect. But it did have an impact on the severity of the flu in terms of work days missed. And so what it showed was that a lot of the symptoms and the severity of the flu might be driven by oxidative stress. And why do we say that? It's because NAC or N-acetylcysteine helps recharge those systems in the body that help reduce and get rid of these antioxidants so that's why I take NAC 600 milligrams twice a day and I usually do it during that winter period for about three months. Yeah me too it completely makes sense you know NAC is the precursor of course to glutathione which is often called the master antioxidant in

the body. And if we're talking about oxidative stress driving a lot of the symptoms and a lot of the problems that we're facing, it stands to reason, doesn't it, that actually if you can make more glutathione, the master antioxidant, that is going to help. And again, coming back to risk benefit, I'm sure there's not as many trials as we would like on NAC to see just how impactful it can be in a whole variety of different situations. But I think there's enough out there to make an educated decision and go, again, very, very low risk of harm and potentially huge risk of benefit exactly yeah super interesting now so we've got vitamin d sleep we've got food we've got potentially nac supplementation for some people you mentioned before that the fins on an evolutionary level did they do something did they kind of figure out we're low in vitamin D

in the winter, so we're going to do some hot cold therapy. And I know this is something you're really passionate about. So I wanted to really sort of get into this a little bit as to heat, cold, how can these things help support our immune system? Yeah. So I really looked into this because I found it just fascinating in terms of the timing and what we've done in the past they go up to two or three times. They have more saunas in Finland. They have enough saunas in Finland that everybody in Finland at once could go into a sauna and there would be enough saunas to hold everybody. And so, it's a great country to study this on. I mean, the Swedes and the, you know, the Nordic countries, they'd use it, but not to the same degree. And I remember when the pandemic first started, looking at Finland to see whether or not they had improvement in their overall outcomes. And they actually, they were the ones that actually had the first case out of all the Nordic countries.

They're the ones that, you know, had shut down just about as much as everybody else. had shut down just about as much as everybody else. Most of the numbers, interestingly, were coming from Helsinki. And there was a Somalian group there in the capital that was having most of the cases. And I thought that was an interesting issue because, again, there may have been a vitamin D deficiency. Again, they're used to having a certain amount of sunlight where they are living. And being in Helsinki in Finland could certainly mean that they would be at risk for vitamin D deficiency. But if you were to take Helsinki out of the equation, they had, well, even if you put it into the equation, they had great numbers.

It was even better if they didn't. So what's the basis of this? Again, let's go back to the two types of the immune system. There is the innate immune system and there's the adaptive immune system. What we now know about SARS-CoV-2 is that the proteins in SARS-CoV-2, and indeed other viruses as well, suppress the body's innate immune system is so well-tuned that for most viruses, you're not going to have a problem. For a virus to overtake the human body and cause an overwhelming infection, it has to have some sort of a mechanism where it cripples the innate immune system. And that is what was discovered with the first SARS virus in 2002. And it's no different for this one in SARS-CoV-2. There's been a number of papers that have been published on this. So the problem is that with the innate immune system

crippled, the body gets infected in many cells, and then seven days later, the adaptive immune system turns on, and that's when we have the cytokine storm. So if it was possible for us to have the cytokine storm. So if it was possible for us to enhance the innate immune system in a way that the SARS-CoV-2 would not have free reign, not infect many cells, we might be able to stop this short. So what I'm talking about is something that we would ideally do right after someone felt sick, but well before they were so sick that they had to go to the hospital. So we're talking about early treatment. So as it turns out, there is a way of enhancing that innate immune system. And it's actually very, very simple. It's with heat. This is exactly what the human body does itself. How many times have we taken, you know, Tylenol or paracetamol over there in the UK to suppress a fever, thinking that the fever was

the problem. It's actually one of the ways that the innate immune system has of signaling to the body that there is a foreign invader and that the innate immune system has to go to work. What they have found in research is that the product of the innate immune system, which is something called interferon, which is a good thing. It's a product that's made by the human body. It's well-named because it interferes with the virus. What we have found that as the body temperature goes up, the amount of interferon that is made goes up as well. In fact, when you hit about 39 degrees Celsius, there's a tenfold increase in interferon secretion from the macrophages in the innate immune system. Now, that's really important because when we look at some of the

papers that have been published with SARS-CoV-2, we're seeing this was published in Science. It was a very prestigious journal, very elegantly done paper that showed that as interferon levels go up in patients, the severity of the illness goes down. Some of the most severe cases of SARS-CoV-2 in this cohort of studies were in patients that had very low interferon levels, either from antibodies against them or from innate inborn errors of metabolism that didn't allow the body to make enough interferon. So clearly, the amount of interferon that is secreted is going to have a huge impact on how the patient does. So that's benchtop. How do we convert that into everyday life? Well, let's go back. Let's go back in history. There was a gentleman by the name, it was an Austrian psychiatrist by the name

of Wagner Jureg. Dr. Wagner Jureg was in charge of an insane asylum in Austria. And he noticed that his neurosyphilis patients at the time, this was back in the 1900s, 1920s, they got better when they had a fever. And so he had this idea that if he could only bring up their temperature, maybe this would impact the neurosyphilis. So he actually infected them with the blood of people that had malaria. So he would actually on purpose give these people malaria. Now he was under a controlled situation and they knew how to treat malaria. But sure enough, these high fevers that these patients had from the malaria cured the patients of their neurosyphilis and then he simply cured the

malaria and they were fine. For this, he won the Nobel Prize in 1927. The very next year was when we discovered penicillin, which is the treatment for neurosyphilis as well as many other things and other antibiotics, of course, came from that. But here's the point. The point is that to do the type of work that you need to do to raise up the temperature, they used all sorts of things. They injected them with foreign proteins. But one of the most common things that they would do is they would put these patients

in heat boxes or heat closets or heat them up with hot towels so that their body temperatures would come up. They'd be sweating. They'd do this for about 20 minutes. And then they would immediately cool them down, very similar to the things that the Finns were doing in their Finnish saunas. And all of this took a lot of time. They had hospital sanitariums that were set up. And it was very labor-intensive. Now they could treat it with just a pill. And so what happened was, it's not that these things didn't work. It's just that they were labor-intensive. And now with the advent of penicillin and these medications, we found things that were much cheaper, less labor-intensive to do. And we've gone down that

road. Now look, I'm an intensive care doctor. I give medications all the time to my patients, and I'm sure thankful that we have them. But it doesn't mean that these things that we used to do don't work. And so I think in a pandemic situation, these are things that we should at least look at and see whether or not they might work in COVID-19. I mean, so interesting to hear that kind of historical narrative there of all these other kinds of treatment modalities, particularly using heat. It strikes me that, as you say, huge benefit for medication in many situations. But also because we presumably got penicillin and we had this quicker easier way to treat people

maybe we stopped studying and researching some of those other methods that actually cultures have been using for so long if you talk to people of certain backgrounds they'll tell you things like um oh my mum used to tell me when I was sick to go and sit out in the sun and put more, I don't know, turmeric in my food, for example. That's not uncommon in Asian cultures. And then we get modern science showing what a powerful anti-inflammatory turmeric and curcumin is. You know, we talk about sunlight in terms of vitamin D, but actually maybe it's also, as you say, we're trying to reduce it as to, it's just one thing, but we talk about sunlight in terms of vitamin D, but actually maybe it's also, as you say, we're trying to reduce it as to it's just one thing, but we know the sunlight or just the

natural light helps us set our body's circadian rhythm. But maybe the heat is also helping the innate immune system function better. It's quite incredible, isn't it? That we're almost having to relearn what we once knew. Yeah. You know, I've, when I've talked about this before, I've had people come up to me from multiple cultures. I've had people come up to me from Asia, from Iran, from South America, and they all have their flavor of how they do it, but it's essentially the same thing. In Iran, they would go into the hot sand and try to heat up that way. If it was in Asia, they did it a different way. South America, it was another way

they did it. But it was all a variation on a theme, which was heating up the body briefly to cause a fever and sweat, and then a cool down. Now, the question is, what's the point of the cool down? Well, scientifically, we now understand that when you heat up the body, you want to lock in that heat and the cold can cause vasoconstriction, locks in that heat and also causes a lot of demargination of white cells that can then go to the lymph nodes to do what they need to do. So it's interesting. And what you were just saying made me think about this.

made me think about this. The sunlight, the fresh air, the hydrotherapy. Looking back, I found this very interesting article published on May 1st, 1919 by Dr. Wells Rubel. Now, Dr. Wells Rubel was the medical director of the New England Sanitarium. This was in Boston. And this was a system of sanitariums that were run by the Adventist Church at the time. And you have to understand that this was after a very famous gentleman by the name of John Harvey Kellogg, who was the medical director at the Battle Creek Sanitarium, who essentially wrote the book on hydrotherapy. This is also the brother of the guy who invented Kellogg's cornflakes. There was a lot of push at the time for understanding of health concepts and things of that nature. Well, he wrote in May of 1919 with the pandemic that was going on that this was an ample opportunity to employ what they called rational treatment.

And what did rational treatment involve? Here you have this contrast, because in the United States, you had these army hospitals that were using a lot of aspirin at the time, because they felt that treating the fever was important, because that maybe the patients were dying of fever. They were keeping them in the army camps inside these closed conditions, minimal ventilation, no exposure to sunlight. And so we knew what the statistics were in the army hospitals. I mean, 20% of them came down with pneumonia and another 40% of them died after they got pneumonia. Whereas in the sanitariums, and there was about 10 of these in the Northeast, what they did was something completely different. They isolated them.

They used no medication, so they didn't use any aspirin. They did hydrotherapy, which was heating up the body, cooling them down. They had them go outside, exposed to the sunlight, fresh air, all of the things that you and I were just talking about. And the amount of patients that went from initially infected with influenza to getting pneumonia was 2%, as opposed to the 20% that was going on over in the army hospitals. The very few that did develop pneumonia, about 50% of those died. So it really didn't work after you had pneumonia, which is why I believe this is more of an early treatment. But overall, the case fatality rate was 6% in the army hospitals, just over 1% in the sanitariums. 6% in the army hospitals, just over 1% in the sanitariums. And when I look at that,

published over 100 years ago now, I look at that and I say, wow, if this could be something that we could easily implement without a pharmacist, without testing, without a physician in any country of the world, so long as they have a way of heating something up, applying it, and then cooling them down. And imagine what we could do in those situations where we couldn't get medical care out fast enough. I think it actually may do quite a bit of good. It's incredibly humbling, isn't it, as a clinician to think over 100 years ago, some really good research was being published that we have somehow forgotten about. I mean, those reductions in pneumonia rates and case fatality rates are hugely significant, especially when you're talking about them getting no sort of conventional treatments,

all they're getting is this hot, cold therapy it's it's really exciting how do you see that fitting in with you know the widespread uh adoption of cold immersion now particularly in the sort of wellness communities uh vim hoff who i've spoken to before on my show vims obviously doing a great job at elevating uh elevating how beneficial certain types of breath work can be for our overall health and for our stress levels. He's also helping to promote awareness of potentially for some people how beneficial cold immersion can be. Lots of people now, through him, through many other methods as well, are trying out various forms of hot colds. as well are trying out various forms of hot colds. It's quite interesting, isn't it, that there's this modern, almost epidemic of cold immersion advocates now. How does that fit in a little bit

with this research from the past? We're also in the UK, I think there's some studies on cold water swimming and how that is helping people with depression. I don't know if you've seen any of those studies, but again, that's super interesting as well. It all fits into this whole big picture that you mentioned at the start, immune system, inflammation. We know many cases of depression are driven through inflammation, right? So help us put all that together, if you will. Yeah, it's a lot of stuff there. But I see a recurring theme over and over again. Sometimes the most helpful remedies for the human condition are not packaged in a pill box. They're actually packaged in nature. And not to say that there isn't a benefit

from these things. I'll tell you, look, if someone comes in to the emergency room and they have a stroke, we are going to get a CAT scan. We're going to give them a thrombolytic. We're going to open up that. I mean, there's nothing in nature that I know that's going to help right at that moment. So what I'm starting to find, if we want to put all of this together, is things that are emergent, things that are urgent, things that are is things that are emergent, things that are urgent, things that are in a pandemic. There are things that sometimes we have to use. Emergency measures require emergency.

Emergency situations require emergency measures. But if we are looking at trying to get toward a healthier existence, I don't think the answer there is going to be in medications necessarily. I think the answer there is going to be in lifestyle and in healthy living. And I think the answers to those things have been around for many years. That's what I'm getting the sense of. Of course, there's exceptions on both sides. But again, I'm an advocate of the Swiss cheese model. If it works, add it to the Swiss cheese. Have you ever heard of the phrase that James Nestor shared with me when he came on my show? I don't know who said it originally. I think he heard it from a friend of mine called Brian McKenzie again. And I'm interested as your take on this, given that you are

an intensive care physician, but you also seem to have this really amazing passion for lifestyle and nature and what we can do for our prevention as well. The quote is, I think that Western medicine helps us not to die. Eastern medicine teaches us how to live. And I wonder what your perspective might be on that, given what you've been talking about so far. Yeah, I think that's a reasonable thing. I would hate to say that the things that are ascribed to Eastern medicine is only in Eastern medicine, because I think, as we've talked about before, a lot of those things were originally all over the world. But I think particularly in the West, we've lost it and ceded it to the Eastern cultures. But I think it was there to begin with, and it still can be. But that's a

very good point. There's another expression that we hear. You may not have heard this. It's more of an American expression that in America, death is optional. So, you know, we always have something that we can do to keep you living, right? So, maybe not so, not maybe with a high quality of life, but it seems to be this binary, you know, alive or dead. And that's that. But that's not what we ought to be interested in. We want to be interested in living fuller lives and enjoying life. And that's something really worthwhile attaining. As someone who does work in intensive care, that idea that death is optional is super interesting. Do you or have you found that you've had to really ask yourself questions about this

in your work as a doctor where presumably you can keep people alive sometimes, where there may be a case that actually is this the best thing for this patient? Is that something you've had to wrestle with as a practicing MD? thing for this patient. Is that something you've had to wrestle with as a practicing MD? Oh, yes. I can tell you because I have cultural connections with the UK. As I mentioned, my mom is a nurse that trained in Birmingham. I have on my wife's side who's Polish, she's got family members there in Poland. It's very different here in the United States. There is no age limit to what we can do or what we will do. And there's something about the American culture that means that, you know, we never give up.

We keep going no matter what it is. That culture is changing. People are starting to accept that a little bit more that, you know, we have to look at quality of life. that, you know, we have to look at quality of life. And I, oftentimes, we'll have patients that have absolutely no quality of life. And we'll be asking families, you know, do we need to put, instead of them being on the ventilator, we'll switch them over to a tracheostomy, which allows them to be on a ventilator in a warehouse, essentially, in an institution, to see if they'll get better. Now, oftentimes it's, it's a reasonable thing to do because they need to rehabilitation. Um, but other times it's just for the fact that, uh, that we don't want them to die. We just want them to stay alive.

And we, we oftentimes, uh, have discussions with families and try to explain these sorts of things, but it is definitely, um, a, uh definitely an area that we spend a lot of time talking to families about and educating them. And I think as a society, America is coming around to understanding some of those issues. That it's not, you know, staying alive is good and dying is bad. The question is more nuanced than that. Do you feel that being an intensive care doctor has made you more passionate about prevention and the things that we can do in the first place to prevent ourselves ending up there in the first place? Have you always had this passion or do you feel that passion has developed as you've gone throughout your career? Yeah, that's a very good question. And I'll tell you,

I did not come around to thinking about prevention as much as I should have until coronavirus came around. And then I had to really start thinking, look, here's a pandemic, people are going to die. We don't have things that we can do to stop it that we know of. We don't have randomized controlled trials that have been done and published in big journals like The Lancet. But let's now start looking at things that we can do to improve our lifestyle so that we can withstand this wave that is coming. And that has really driven me because I've had to look at these things to be able to dissect them and find out what it is that works. to be able to dissect them and find out what it is that works. But now that you mentioned that, when I go back to the ICU, yes, a lot of the diseases that I see in the intensive care unit are the result of abuses that have happened over years and years and years, whether it's smoking, whether it is drug use, whether it is alcohol, all of these sort of abuses that have occurred cause these patients to show up. And in the United States, we have, and I'm sure you do as well,

have rules against, they have rules for keeping things private and not talking about patients and names and things of that nature. But I would really love if we could somehow do this, have the public come in and see the type of things that happen with some of this living and see the results at the end so they know where this is leading to. I think that would be very educational because people don't see it and we can't talk about it. Yeah.

One of my best friends, a chap called Karen, he works in a place called Chamonix in France, the foot of Mont Blanc, and he's an acute care physician. He works in the ER there. He works in intensive care there. And a few years ago when I was in Chamonix on holiday, I remember saying to him, because he knows what I do and that I'm all for promoting healthy lifestyles as much as possible with as many people as possible. And I said to him many years ago, hey mate, I guess it's not as relevant for you because you're seeing people who really do need acute medicine and the best that we've got. And he said, no mate, not at all. It's even more relevant for me. i'm often sitting there

in a and e talking about the stuff that you're talking about that they could do for their for their mood or their lifestyle it is just as relevant so it's fascinating for me to hear that from my friend but also from you in a completely different country a different healthcare setting your experience as an acute physician is helping you, well, or reminding you and all of us just how important paying attention to our lifestyle is. Yeah, it's so sad, the things that we see on a daily basis. Yeah. Now, one of the things that people often say about looking after ourselves is that it's expensive and it's not accessible to all socioeconomic groups in society. And if we just talk about, if we talk this through about what we've spoken

about so far, vitamin D supplementation is very cheap, super cheap. Improving our sleep, there's lots of things we can do that are free. Now, I appreciate there can be a lot of stress in low socioeconomic groups, which can make it harder, for sure. I don't want to sort of pretend that that's not going on. But again, there's a lot of simple things that we can do, looking at natural light when you wake up, not looking at screens in the evening, caffeine consumption, having it in the morning, etc cetera, et cetera, that is accessible to people. There is a debate on whether it's cheap enough to eat healthily. And I mean, that's another topic, but I think there's good evidence to support that actually many of these foods are affordable for

many people. If we use that to hot, cold therapy, because I want to make sure i really believe that good health is accessible to everyone or it should be and i feel as physicians we we really should as much as possible be making sure it's accessible to as many people as possible not everyone has access to a sauna not everyone can afford the gym membership to have a sauna they can't afford to have one in their home. They don't have the space. So how does that hot cold therapy apply itself to all of us? Yeah. So first of all, before I forget, there are some great websites that I didn't create, but I know that are out there that can talk more about this for your audience. So the first one is hydro, the number four, audience. So the first one is hydro, the number four, covid.com. So hydro for covid.com. And that one's actually was created by a physiotherapist in Australia that really studied the protocols

of John Harvey Kellogg and what he did at the turn of the century. And then there's another one that's even more practical than that, called hydrotherapyathome.com, all one word. And that has a number of videos on there and also just really how to do it yourself. And what it shows in those videos is how easy this is. So literally, you can have a pot of boiling water, you can have a microwave, you've got to be very careful not to burn yourself in these things. But basically heating up a wet towel and applying it on the body with a dry towel in between so you don't burn yourself, both on your back and your front. And you basically cover yourself up in a towel to keep the heat in for about 20 minutes until you have your sweating on your lip or your forehead. That means that basically your body temperature is going up and your body is trying to cool itself down, but you're not going to allow it to do that.

Putting your feet in a hot foot bath, all of these things are ways of increasing the body temperature and have been used for decades, for probably hundreds of years to do this. And then after about 20 minutes of this, taking it all off and then applying a very cold, wet towel over the chest and applying kind of a friction to stimulate and to cause vasoconstriction of the blood vessels and allow the demargination of the white blood cells. These are things that I didn't make up, but I'm learning about it. There's a number of institutes here in the United States that are actually doing this on patients. One of them is called the Weimar Institute here in Northern California by Sacramento.

They have a number of people that have been doing this for years. There's been a number of schools that used to teach this. They stopped teaching it back in the 70s because they thought it was useless because who's going to do this, right? It's very labor intensive. But there are a few people that know still how to do this and it's a sort of a growing art. There's been a lot more interest, obviously, because of coronavirus. But if you go to those two websites, they will show you how to do it. But you're absolutely right. This is something that can be done very easily in a situation where you don't need to have

a lot of money. In fact, the gentleman who did the website Hydro for COVID was a consultant when there was an outbreak in Laos, actually, where they were showing them how to do these in refugee camps. And they could use black plastic bags and sit out in the sun and sort of heat up with trash bags and then cool off. So there's different ways of heating up the body, getting that temperature up and then cooling down. So it's very inexpensive. How do you do it yourself? If you do it all? I do. So if I want to just as a tonic want to make sure that I'm supporting my immune system, I actually have a spa that I've wired up to 104 degrees Fahrenheit. And we measure it in Fahrenheit here in the United States. In the United States, it's a law that you can't have a spa or a jacuzzi go up to more than 104 degrees.

So that's how I do it. But if I'm really serious about it and I really want to do it right, then I will spread a mat out. My wife will help me. We boil up some towels, put it down on the towels, lay on it, and then she'll put the towel over me. I'll put my feet in a hot foot bath that's really, really hot but not burning. And you'll do that for 20 minutes. And I'll tell you, boy, you feel you start to sweat all over your body. So you have to be well hydrated. And after

about 20 minutes, she'll put that cold on. And it's interesting because you feel so hot that you would think that cold is something that you don't want to have, but you're actually waiting for that. It's so hot. And then after about a minute or so of that, you go have a shower, you lay down in your bed, you feel exhausted. But boy, I've done this in a couple of patients with COVID-19. They've called me and I've explained to them what to do and how to do it. And the symptoms, at least in those, and this is not a study, this is anecdotal, the symptoms abated very quickly after about a couple of days. So that's in the early phase when people have just got sick, as opposed to in the late stage you were talking about earlier.

Exactly. So you don't want to wait for a test. I mean, if you're feeling bad, if you're feeling like you have a muscle ache, you don't know if it's COVID-19 or not, but it doesn't matter because this is going to help the innate immune system, which has to do its job anyway. So you don't need it. The beauty is you don't need a test. You don't need a doctor. You don't need a pharmacist to initiate this. Now, I'm not saying you shouldn't get those. What I'm saying is this is something that you can do in conjunction with all of the other medical infrastructure part. What about hot and cold showers? Is that a simpler way and an easy way for people to try and

activate some of these mechanisms that you've been talking about so far? Yes, absolutely. These are known as contrast showers, the contrast being the hot and the cold. Yes, absolutely. These are known as contrast showers, the contrast being the hot and the cold. And the people that are the experts on this that I have learned from have come up with a formula that they believe will work. And it's five minutes hot, and then one minute cold, and then three minutes hot, and then one minute cold, and then three minutes hot, and then again, one minute cold, and then you're done. So if you add all that up, it's about 19 minutes or so if I do my math correctly. But this is more of a tonic. So this is something to keep your immune system up and running and making sure that it's surveying. If you start to come down with symptoms, I would probably recommend not doing the contrast showers,

but doing something a little bit more aggressive, like what we just talked about. Yeah. Do we know what temperature we need to get up to on those hot, cold showers? Did they specify at all, or is it just hot and cold? Because of course, cold at different parts of the year. In the height of the summer in the UK, if we're having a good spell of weather,

hey, a cold shower is pretty easy. It's like, yeah, I'm having a cold shower, but you try that in January, it's a very different'm having a cold shower but you try that in january uh it's it's a very different experience of a cold shower yes so you you they do actually specify and i'm not i'm remembering the numbers exactly but in fahrenheit you want the hot as hot as you can tolerate it and you really want the cold like down into the 60s or 50s uh that's kind of where you want which is pretty cold in terms of other things other simple things that we can do you mentioned before you said i think that there's a lot of great things that come packaged

up in nature yeah and nature itself can be good for our immune system for for multiple reasons and i wonder whether you could speak to some of the benefits there are for our immune health when we get out in nature. Yeah, absolutely. So there was a study that was done a number of years ago by some oncologists that were looking at a way to support their patient's immune system while they were getting chemotherapy. Chemotherapy, as you know, kills cells, the rapidly dividing cells of cancer, but unfortunately, it also makes an impact on the immune system. So what they decided to do was add something called eucalyptus oil, so the oil of the eucalyptus tree, to an in vitro study. And it showed that the eucalyptus oil stimulated the innate immune system in terms of phagocytosis, that's eating

bad things up, just as much as something called lipopolysaccharide. And for those of you who don't know, lipopolysaccharide is a component of the cell wall, if you will, of gram-negative bacteria. So in other words, bacteria activate the immune system. Eucalyptus oil does it to the same degree. And it actually makes sense. If you look back again at the pandemic of 1918, eucalyptus was used extensively. People knew that eucalyptus was a great antiseptic immune booster. In fact, even today, it's one of the active ingredients in Vicks VapoRub that your mom probably rubbed on your neck when you were... She did. Yeah. So, in fact, if you smell eucalyptus oil, you'll say, oh, this is Vicks.

So, eucalyptus oil, and that's just one of the aromatic compounds from one of the trees. So, there was a study that was done in Japan where they took these Japanese, these really well-to-do executives from a Japanese company, and they took them up into the Japanese forest where the Hanoki cypress tree was indigenous. And they had them walk around for a couple of days in the woods, and they measured what they call phytocides. Phytocides are these aromatic compounds that are given off by the woods. And they measured what they call phytocides. Phytocides are these aromatic compounds that are given off by the trees. And they measured the innate immune system, the cells associated with the granules in the innate immune system, chromogranin A, chromogranin B, all of these things that go out and fight and are basically surrogate markers of the immune system. And what they found was that there was a definite elevation in all of

those things when they went out into nature and they were exposed to these phytocides. So you say, okay, well, what was it? Was it the fact that they left work? Was it the fact that they went up to altitude? We don't know what it was. Well, they knew that. So what they did was they took them now and they went back down to Tokyo. They put them in a hotel and they infused in the room the hanoki cypress oil okay and they found the exact same effects as they did when they were up in the forest but there was one exception and the one exception was is when they measured the cortisol levels in the urine now you and i know that cortisol levels are a surrogate for stress. What they found was the cortisol levels in the hotel room were higher than the urine cortisol levels when they were up

in the forest, which means that they were not only getting the benefit of these phytocides, which by the way, lasted for about seven days. Not only were they getting the benefit of that, but they were also getting the benefit of reduction in stress overall as measured by cortisol levels. So there is a benefit in getting out into nature in terms of relaxation, but there's also an added benefit, and it doesn't have to be Hinoki cypress trees. It could be the fir, the pine. They all give off these phytocides that are natural compounds that seem to affect us in a way that it boosts our immune system. Yeah, it's incredible. I remember reading some of those studies a few years back, and I think in one of them that you mentioned, I think they even showed that the body's natural killer cells, of course, are a very important part

of our body's innate immune system that helps us eat up viruses, for example. That went up significantly, I think, in that study, if my memory serves me correctly. And I love the fact that in Japan, they've got this term for it, forest bathing. It's this cultural thing that they do. I guess in terms of trying to make practical recommendations, you're saying that actually those benefits lasted for about seven days. So could we extend that and say to people listening, to families listening, say, hey, look, maybe there could be, maybe we can't say this for sure, but incredible benefit from a long hike in nature once a week you know do that as a family it's

going to help bond you together it's going to help lower stress but you may also be boosting your innate immune system and maybe that will last till the following weekends oh you you are taking the words right out of my mouth this is exactly where i i want to go with this because this is the this is the next level you knowals are, right? The fractal is a pattern and then there's a pattern within a pattern. And this is the next pattern up when we're talking about sleep in the 24-hour pattern because now we're going to the weekly pattern. And science has shown very, very clearly that there is a seven-day cycle to the human body. clearly that there is a seven-day cycle to the human body. And if you think about it, this is quite remarkable because if you look at the patterns that we have in society, right, we know

that a year is related to how long it takes for the Earth to go around the sun. We know that a month is the time it takes for the moon to go around the Earth. We know that a day is the time it takes for the Earth to rotate around its axis. What we don't have is some sort of an astronomical way of understanding why do we seem to be attracted to a seven-day period. And yet every culture on the planet works on a seven-day period. I mean, in the French Revolution, they tried to go to 10 days. It just didn't work. They had to go back to seven days. And in fact, when we look at the human body, and we look at the natural cycles in the body, we know that there, of course, is a circadian rhythm. But there's also a seven-day rhythm in the human body, as we've just pointed out here with this

study. But there's other ones that are related to seven days as well. And it seems as though we need to have a day off. I remember I was watching actually one of your videos where you were talking about the fact that we just keep getting inundated by social media, by pages, by phone, 24 hours a day, seven days a week, it seems. and that sometimes we need a time period to just shut down. Well, we don't have that. We have this sort of this period of time for self reflection, I think was the words that you use. And I totally agree with that. I think that's one of the missing parts that I think is really important. Yeah, I didn't know all of that about seven-day cycles. That's super interesting.

I certainly didn't know that in the French Revolution, they try to go to 10 days. It's really interesting. And I guess it speaks to this, the sort of wider connection that we as individual humans have to our heritage, but also, I guess, the planets, the moon, the sun, the sort of things we often don't talk about in medicine. I think it's always nice to put ourselves in that wider context. And I guess, when we're thinking about health, Dr. Schwelt, how do you see that connection to something beyond ourselves? How important is spirituality spirituality and these, I guess, what we would call in medicine, the softer things rather than, you know, vitamin D will do this to your immune system. Sleep will increase natural killer cells. You know, these kinds of things

that we can measure in very clean ways. You've been practicing, I think, I don't know how many years now, for me, it's just over 20 years. I imagine for you, it's been a long time as well. How do you look at these things? How do you look at the sort of wider big picture and spirituality in terms of our health as well? Yeah, well, absolutely. And I've been practicing for about 20 years too. I think maybe we came on the scene around the same time. I see it as something that's universal. Look, I mean, look at there was a famous television show here in the United States called chairs. You maybe you've you've heard of chairs? Yeah, right. So what was what was the what was the main theme in the in the words, you want to go where everybody knows your name?

What was the main theme in the words? You want to go where everybody knows your name, right? You want to belong to something. You want to be a part of something. You want to have – there's something about being a part of a family, being a part of some sort of a belief structure, and having something that you can depend on and someone that's going to be there for you. someone that's going to be there for you. And I think the studies have shown, you know, time and time again, that people that are in those kind of systems seem to do better than those that are alone, that those that have to deal with things by themselves. I think we're social creatures. And, you know, talking about the spiritual aspect of it, you'm, I'm informed by my own spirituality as well, um, as being a seven day Adventist growing up here in a blue zone. Um, so that's kind of where I'm, I'm sort of,

of coming from this. Um, uh, Dr. Dan, or Dan Buechner from National Geographic did a story a number of years ago on these blue zones in the world. One of them was in Sardinia. The other one was Okinawa, Japan. And the other one was, you know, Loma Linda in Southern California, where you can't see the mountains half the year because of the smog. So like, why Loma Linda? Well, it seems as though it has those ingredients. The interesting thing about Loma Linda is that it's not a genetically homogenous group. I mean, in Okinawa, Japan, you know, homogenous. In Sardinia, homogenous. Here in Southern California, you know, you have African Americans, you've got Hispanics, you've got Caucasians, but they're all part of the blue zone. And the reason that he felt was

is because of all of those things that we've just talked about. Diet, feeling of togetherness, resting one day a week, being able to turn things off, and belief in a lot of these things, fresh air, exercise, getting outside. So I think that's where I would be coming from on that topic in terms of spirituality, is being a part of something that informs you and allows you to put your faith in something, that informs you and allows you to put your faith in something. And you're not exposed to the ebb and flow of risk and stress by yourself on a daily basis. Yeah, so interesting. And I didn't know that Loma Linda, I've spoken to Dan before,

I'm a big fan of Dan's work. I knew that was a blues song, but I didn't know it was not genetically homogenous. So that really speaks to the power of the environment, doesn't it? And epigenetics. And it's really, really fascinating. You mentioned a couple of things there, which I thought were really interesting, Dr. Schweltz. You mentioned that one day off a week to sort of switch off and rest. And I was actually explaining to my kids in the last couple of days, I was saying, hey guys, you know, when we were little, the supermarkets were closed on Sundays. You couldn't buy anything on a Sunday. Like that was a day where you would just rest really. You know, I remember when I first started going to France, even recently in France and a lot of

towns in France, the supermarkets are closed on Sunday. You have to do your shopping on a Saturday or you don't have the option of going on a Sunday. Now that is changing as we become more global and international as societies, these sorts of things start to change. But this idea that you can now shop seven days a week, do the same things on a Sunday or whatever day you choose to have that. Of course, different faiths have different days where they switch off. And just having that one day where you're not doing the same things, allowing your body to reset. Maybe it's that one day where you go with your family, if you're lucky enough to have a family, out into nature for two or three hours and get all those benefits. There is science behind it, but there's also something behavioral and cultural around this

that we can bring in as well, isn't there? Absolutely. Oh, totally. And I can't tell you, I mean, it's almost like it's a spot on the wall that, that allows you to divide the endless demands that society and your work places on you to say, I'm taking a break. And once you, once you've decided to say that this is what you're going to do, it's so easy then to say, to say, I'm not going to do, I'm not going to go to work. I'm not going to go do these things because this is the protected time that I have to take care of it. If you don't have it, if you haven't made that commitment, it's easy to allow things to creep in. Even if you have made the commitment, it's easy to allow things to creep in. So you have to have that. You have to start out saying it and you

will see that the benefits of being able to just put those things out of your mind. And I'm so surprised that, and now I'm not so surprised, because sometimes when you put something down and you don't think about it, and then you come back to thinking about it again later, you see things in a different light, maybe a clarity that you didn't have before. So there's so many benefits. Is that something you find hard as a busy physician? There's a lot of patients who are depending on you. Of course, there's a lot of stress and demands with the job, but you also managed to find time to make some incredible educational videos that have literally helped millions of people get a better understanding of their health over the past few years, which,

you know, I want to acknowledge you for and just say what an incredible job you're doing at that. How do you manage that yourself? Because there must always be something else to do, right? Do you manage to actually have that switch off? Or have you got some strategies that you try and implement? Yeah, it's been difficult. It was a lot easier before the coronavirus pandemic. And since that time, things have just sort of taken off. But what we've tried to do is I've tried to keep, you know, things like so I don't make videos. I don't conduct business or do those things on the Sabbath as Seventh-day Adventist Friday night to Saturday. So it's very similar to the Jews.

But so I've made that a priority. But then I've also tried to make a priority with because I have three kids as well. And they're all in school and they all want to, you know, to, you know, socialize and do things. And so you have to make a priority of things of what is what is important in your life. And that is always difficult. You have a job to do. Obviously, there's times when I have to work in the intensive care unit on days that I would prefer to have off, on that day that I would prefer to have off. And so I use that as an opportunity to see things a little differently. Perhaps I might spend a little bit more time with my patients. Oftentimes, I pray with my patients. And as a physician at first,

when I would start to do that, I was very self-conscious about it because I thought that patients would not want to have that. I have to tell you that I have not had a patient once say, no, I don't want to do that. So, to me, it's been a blessing in that in terms of me connecting with my patients. And I can see when I do that for my patients that they, it's almost like a weight has been lifted off. And it's funny, too, because they'll call their friends or their wife at home and they'll say, you wouldn't believe what happened today. The doctor prayed with me. So I can see that it's touching them. And it goes again to what I was saying at the beginning beginning it's this universal thing everybody wants to go where everyone knows

your name it's just like that that show cheers really hit something i think that's why it was such a hit because um yeah we're not we're not meeting some of those needs and i think that discomfort you felt right at the start probably speaks to, you know, I fear we all want to connect with others, but I guess the way we feel culture's gone, we feel we can't open up, or we can't be ourselves, or we can't share. Again, as a doctor, you know, I've faced this myself in the past, you know, should we have a certain image in society? Do we have to behave a certain way to be the doctor for this patient? one thing i've learned in in my years of practice is the more i take off my masks the more i just be myself right and let that patient see this

shared common humanity that the better the connection is and i honestly feel the better the health outcome is as well when I do that. Absolutely. I mean, now you're not just a guy in a white jacket. You're now a human being that they can connect with. And I think patients really appreciate that. Yeah. Well, Dr. Schwartz, just to start wrapping up this conversation, a huge part of today's chat has been about the immune system and inflammation.

huge part of today's chat has been about the immune system and inflammation. Of course, there's many other areas we could have gone down and I'm sure my audience will love this conversation. So if we can get you in the future, we'd love to go deep again on some other topics. But regarding immune system health then, I don't know if you'd be open to sharing, you know, you're a super world respected respected physician you've shared a lot of science and data around the immune system you you work in intensive care are you willing to share what you do on a daily basis to help protect your immune system as a way to inspire us to think about the things that we can do and i appreciate you may have covered some of them already but just as a way of sort of summarizing this towards the end yeah absolutely, absolutely. So, you know, I try to get sleep early.

It's hard for me to do that as a physician, but try to get to bed early, try to get up, try to expose my eyes to bright light in the morning, make sure my immune system is locked in there. I try to get outside. I've got a couple of acres with some trees and some plants and vegetables. I get out there as often as I can

and work around in the garden and fix things and try to get some exercise. Sometimes if I can't do it, it's in the wintertime, I'll just on purpose get some exercise, play with my kids. It's important to get exercise. That's one of the things that we didn't really delve into. We can save that for another time. But exercise is really important in terms of reduction. There was a study that just came out showing that people who exercise have reduced incidence of severe COVID. So that's really important. And, you know, that aspect of making sure that you have enough sleep, but also making sure that you're resting on a weekly basis, getting away from the din and the rat race so that hopefully you can reset. In terms of supplements, I take vitamin D, 5,000 units every day. I've done that because I've had my blood tested and I

wanted to get it up above 50 and that's what it took for me to get it up above 50. Even though I live in Southern California, that should tell you. When you live indoors and work indoors, that's an issue. I also take NAC as well. My wife gives me some B vitamins as well. And fortunately, she's the one that puts it on my plate in the morning. Otherwise, it was up to me. I would probably have forgotten. And then, you know, I take great pleasure and pride in, well, let's say pleasure in terms of making these videos and helping um other people and i think that's what we all ought to do is is you got to do something that you feel you you've been called to do in terms of a purpose and i think that helps if you find something that you like to

do then as they as the saying stage as the saying goes you'll never work a day in your life yeah some really really practical tips there for people and yeah i love what you said that you you've been measuring your vitamin d levels to make sure you're getting to that optimal level and of course people wherever they are they have access to that they can also do the same thing as you say exercise really really important we didn't mention that we'll save that for next time i think there's a lot on sleep we could have discussed yeah and maybe fasting and things like that which again we'll probably absolutely dive into next time but but i really just want to say thank you because um it's been a real honor for me to talk to you for for close to two hours uh i know it's late for you so i

really appreciate you making time in your busy schedule yeah but you've clearly found something that is your purpose and your work with your patients, but also your work online. So thank you so much for that. Final question, I guess, this podcast is called Feel Better, Live More. When we feel better in ourselves, we get more out of life.

You've shared so many tips today that we can do to improve our immune system health. But if I was to ask you, what is the one thing that we can do to improve our immune system health but if i was to ask you what is the one thing that you can do in your life that helps you feel better and get more out of your life what would it be i wish i could get into the spa more often it's it's it's really nice when you get in there and you get out um um think that's one thing that I wish I could do more. The other thing I wish I could do more is sleep. I think that's probably more than

anything else, the thing that I probably don't practice as much as I should, as I preach. And that's a problem when you're a healthcare provider and you're expected to be up at all hours of the day and have all of these responsibilities. But I think for me, the irony is I'm a sleep physician and I probably don't sleep enough. I appreciate you being honest and sharing that. I think a lot of us could, I think, again, hearing that from you makes a lot of us presumably feel less guilty because we can know things, but it doesn't mean we can always put them into practice. Dr. Shwell, if people want to follow you and find out more about you,

where are the best places they can find you? Well, thank you. So on medcram.com is our website. We have a number of videos there, also some videos for healthcare providers. For instance, if you're interested in learning about EKG and things of that nature that's available but um obviously on youtube uh we have a channel there megcram as well but we're also on twitter and instagram yeah so everyone go and follow dr schwart there catch up with what he's doing again appreciate your time and i look forward to the next time we get to have a conversation thank you so much, Dr. Chatterjee. Really hope you enjoyed that conversation. As always, do think about one thing that you might be able to take away and start applying into your own life. And as always, do let Roger and I know on social media what you thought.

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