Carona Success In Japan, How Did They do It?

Reference: The Guardian, NYture, Weston Price Foundation,


Just a month or so ago Japan was mired in Olympic cancellation controversy and foot-dragging over their response to the COVID-19 threat.  Dire warning about an upcoming disaster with headlines of doom were common.   Now, they have only had 16,000 cases and 784 deaths out of 126 million people, most of them much older than us.   That's on the order of 5% of what's happened here in America with similar demographics. Last week in Tokyo, with 14 million people, Japan had just 3 new cases one day. New York is celebrating being under 100 deaths. How did they do it?


Now many large public venues like theaters and sports venues shut down earlier than in most countries. Prime Minister Abe even took heat for closing school sooner than most countries. Japan did move to stop crowding and the confined spaces early, which is remarkable when you consider their subways and trains with hired pushers to force extra riders to fit in. But most of the credit is being given to the natural instincts of Japanese to their own personal habits of polite public behavior and personal discipline. When folks have a cold in Japan or even a slight hint of spring hay-fever, they don a mask in public. That's just expected!


But there is some conversation in Japan going around that suggests it's also Japanese food and their inclination to eat natto. This may not be as crazy as it sounds. Follow this thread. Natto is a unique Japanese food. It is made from fermenting soybeans in wheat-straw that is a rich source of Bacillus subtilis, a bacteria that naturally makes lots of Vitamin K2. I mean really lots. One teaspoon of natto has 150 mg of K2, some 150 to 200 times the content of any other food. There is a quaint legend about its discovery 1,000 years ago when soldiers, cooking soybeans were called into battle. They dumped the half-cooked beans into some straw and left. Five days later, starving and exhausted, they remembered those beans and returned to the scene. It had rained. The beans were fermented, all gooey and stringy. They tasted delicious and natto was born. It is a unique Japanese dish and not all outsiders find it delicious. (Google Youtube "Eating Natto for the first time.")


Now K2 is slightly complex in its biology. K1 is well-known from dark green leafy vegetables. It helps clot blood. Animals that eat dark green grass make K2 (actually MK4) from the K1 in their gut. Guess what happens when you move your animals off the pasture into a feedlot and feed them corn and beans! You get virtually no K2 in their meat. The food chain from green grass, to animal's gut bacteria to human consumption relies on being grass-fed. In America we get little K2 at all unless we make a real effort to buy grass raised animals, never fed beans and corn. Now K2 has very little blood clotting effect and plays a dramatically different role in calcium proteins, both in bone and coronary arteries. Weston Price even noticed, over 100 years ago, that heart attacks declined during the season when butter and milk from grass-raised cows was available. K2 and D were part of his Activator X which he felt helped control many illnesses and was a critical component of healthy populations.

But was does K2 have to do with COVID-19? We aren't sure but there is this curious link with K2 and D and immunity. And then there is Japan with its amazing, serendipitous salutary response to COVID-19. And finally we know there is a strong effect of Vitamin D with COVID-19, and K2 appears to augment or make synergy with Vitamin D. Hmm.


www.What Will Work for me. Now, in my world, I maintain that everyone should be taking K2 for bone health and heart disease prevention. I take it. But K2 explains to me why Japan has done so well with COVID. There remains unexplained physiology about immune response and K2. Vitamins don't work in isolation. They work in complex webs in association with other nutrients. It is complex to parse out the separate actions. I'm awestruck at Japan's disciplined public behavior. Compare that to our bar scenes and boardwalks on the news. That just doesn't happen in Japan. But K2 is one simple intervention you should be undertaking just on general principles. If you take D, you should be on K2 as well.  Time will eventually tell.  Oh that I had 30 more years to track that data.  I want to live long enough to see Weston Price proven right.  


Pop Quiz

1.  Vitamin K2 comes from where?    Answer: either from animals that eat green plants, like grass, or from fermented foods like natto and sauerkraut.

2.  American K2 has done what in the last 70 years?   Answer: dropped some 80-90% because all of our animals

3.  What did Weston Price observe about K2 and D?    Answer: they were synergistic with each other.  He didn't even know it was "K2".  He just found the effect of grass raised butter was pretty potent.  Even cured cavities.

4.  Have you ever tried natto?    Answer:   ____________. Should you?  Well, how about some grass raised meat.  Or heck, just take the K2, MK4 form and be done with it.  Rest of your life.  100 mcg a day.

5.  What might be Japan's other secret weapon?    Answer: Strong public ethic of self-responsibility and consideration for others.  That we should have a little of that!


COVID-19 Strategy: Focus on Vitamin D

References: ZME Science, SSRN, Vitamin D Council, Science, SSRN-Philipines


This might be the most important action you can take to build your immune system up to fight COVID-19.  Yes, most important is just to not get it by lowering your risk of exposure, social isolation, hand washing, avoiding face touching, etc.  But focus here, Vitamin D appears to play a central role in your immune system.  Here is how.

First of all, the biology of Vitamin D.  You make it in your skin when UVB rays from the sun hit a cholesterol molecule and break one chemical bond open.  At age 20, a Caucasian American will make 20,000 IU of Vitamin D in June (sun directly overhead) with 20 minutes of mid-day sun.  At age 70, that same person will only make 5,000 iu in 20 minutes. Skin pigment protects the degradation of folate by sunlight but slows down Vitamin D production.  Africans living in Tanzania, getting optimal sunlight, have D levels of 40-55 ng living on the equator. 


But living in northern cities, mostly indoors, African Americans have Vitamin D levels of 5-15 ng (personal research of roughly 500 ER patients).  That is severely deficient.  (To convert nanograms to nanomoles, the unit used in European studies, multiple ng by 2.5: 12 ng equals 30 nmoles).  It is becoming widely accepted that Vitamin D has been the driving force of human populations' skin pigment.  Folks living further north in Vitamin D deficient environments succeed only if they develop lighter skin, allowing them to generate D.  That's why folks from Ireland, Scotland, Norway, Finland, and Russia sunburn so easily too.


You won't get rickets (severe Vitamin D deficiency) if your D level is above 12 ng, so some consider that as sufficient.  However, there is clear and compelling evidence that you need a level of 32 ng to turn on cathelicidin, your natural antibiotic.  Optimal levels of D then become 40-80 ng to defend against virus assaults.  You can't protect yourself against virus infections when your D level is below 30 ng.  In Wisconsin, Caucasians drop their D levels down to 20 ng during winter and rise up to 45 ng during the summer.  That's why influenza shows up in winter.  And goes away in summer.  A meta-analysis of 17 studies has shown that Vitamin D is strongly associated with viral infections.  The higher the D, the less viral infections.


This week's focused study is from Indonesia.  780 lab-confirmed cases of COVID were reviewed for Vitamin D levels and mortality.  The majority of folks with insufficient low levels of D, with preexisting conditions, died.   Another study from the Philipines put it into risk ratios.  Folks with healthy levels of D had a 19.6 fold risk reduction of death.  Did you get that?  Read it again.  19.6 fold.  This observation explains part of why folks with skin pigment appear to be more vulnerable, why nursing home residents are more vulnerable, why northeast American States have done worse while southern, sunny states have done better.  It suggests that the virus will calm down a little during the summer but roar back in November (just like influenza did in 1919).  It suggests that Africa will not be as severely affected.....unless you are really crowded, poor, diabetic, overweight.


But here is the rub.  Vitamin D isn't a drug.  It is a hormone tasked with turning on genes.  That takes a while.  Drugs work in 20 minutes.  DNA and genes take days to weeks to start working.  Fundamentally, Vitamin D turns stem cells into mature cells.  It is stored in fat tissue. Overweight folks are almost always more deficient.  If you just start taking a dose of 5,000 IU a day (5 minutes of sunshine in a young Caucasian), it will take over a year before you come to a new plateau. Because of the phenomenon of soaking up into fat tissue, you need a loading dose to get started.  Most folks who haven't been taking Vitamin D need at least a 100,000 IU loading dose.  African Americans need two loading doses, back to back.  Each dose will raise your blood level about 14 ng (on average).   To optimally protect yourself, you want to be on Vitamin D for several months before you get exposed and to have an optimal level when you are exposed.  If you are elderly, your skin just doesn't make it anymore, and your dermatologist yells at you for being out in the sun.  You just have to take it as a supplement.  And best of all, a blood level to guide your decisions.  Remember, 19.6 fold increased risk of dying.  Plain and simple.


www. What will work for me.  I'm older, living up north, with some propensity to be diabetic in my genes.  If I get ill with COVID-19 and have no D, I'm toast.  Taking it once a month has been touted as adequate because it simplifies taking it.  The problem with that is remembering.  There is some evidence that taking D every day is actually better.  I suspect it is mostly because you get in the habit and remember to do it.


Pop Quiz


1.  To fight viruses optimally, you want Vitamin D to be what level?     Answer:  At least 32 ng or 80 nmoles.  Much higher than many recommendations for preventing rickets.


2.  Folks living in northern cities have normal levels of D?     Answer:  False


3.  African Americans with skin type 6 (very dark) need the same amount of sunlight to make sufficient Vitamin D.  T or F.    Answer:  Horribly false.  Proably need up to 6 times as much sunlight, which you can't get when you live indoors, in a cold climate, far up north where for 6 months a year you make no vitamin D at all.


4.  How well does Vitamin D sufficiency protect you from dying with COVID-19?    Ratio of 19.6


5.  What should you do with Vitamin D to get started?   Answer: Get a blood level, take a loading dose of 100,000 a day for every 14 ng you are below 50 ng and then take 5,000 iu a day

Don't Eat Plastic

References:  Consumer Reports, Lancet, Marine Pollution Bulletin


During these COVID-19 times, you and I are not going to restaurants.  We are ordering carry out.  It comes in plastic containers.  We take those home and plop them in the microwave.  With that, you are getting about a credit card worth of plastic a week into you.  Hmmm.  

If you take the industry spin on exposure to plastics, you will hear an extolling of the many uses of plastics that make our lives easier and better.  There is "very little" evidence of harm.

But if you drill down to sizes, you will find that plastics break down to micro and nano-particles and have been found in Antarctic snow, Hawaiian beaches, Mariana Trench sediment.  They are everywhere.  Out of them leaches the chemicals that make plastics so versatile and flexible: Bisphenols, styrene, and phthalates.   Leonardo Trasanda, MD, director of the NYU Center for Investigation of Environmental Hazards (author of the book: Sicker, Fatter, Poorer) details the endocrine-disrupting effects in plastics.  Parts per trillion are now measurable, and our amazingly delicate and finely tuned endocrine system responds to those levels.  This results in measurable effects when you do the magic of population epidemiology: 10,000 extra deaths per year of cardiovascular disease in men from the damaging effects of phthalates.

That's not the whole problem.  Those tiny little particles are even more surreptitiously nefarious.  They bind and soak up other wicked chemicals like PCBs, long banned and no longer sold, but circulating in the dark underworld of our environment.  Plastic Microparticles pick them up and carry them around.  You get the back when you ingest those ppt (parts per trillion) of plastics. 

We collectively raised enough fuss about BPA back in the 2008 era to force most plastic manufacturers to reduce their use of BPA.  Want to know what happened?  Yup, bisphenol-S and bisphenol-F showed up,  (It's NOT bisphenol-A after all.) says  Patricia Hunt, of Washington State's School of Molecular Biosciences.  She published a report in The Lancet suggesting that our traditional form of measurement underestimates the total BPA exposure by about 44 fold.  We have left out all the metabolic breakdown products.  Same problem with phthalates.  Fetuses and pregnancies pick it all up and you get measurable results showing quite high levels.

This isn't any fun. We have to find a way of taking this seriously.

Consumer Reports details 6 steps you can do to keep yourself less plasticized.

1.  Drink tap water, not plastic bottled water.  (Unless you have lead or copper in your tap water)

2.  Don't reheat your food in plastic containers.  Stop it.  Just don't.  Glass or ceramic instead.

3.  Buy and store food in glass, silicone, or foil.  Plastic codes 3,6 and 7 are the worst.  If you do use plastic containers, opt for codes 1 and 2.  But still don't reheat anything in them. Ever. 

4.  Eat as much fresh food as possible. Even canned foods are lined with plastics.  You can take reusable cloth bags to the grocery store to hold your vegetables instead of the plastic bags in the vegetable section.    

5.   Clean up dust in your home.  Vacuum and wipe dust up. It has a lot of microparticles in it.

6.   Act.  Join local groups that encourage zero-waste behaviors.  Help Upstream, a nonprofit working to create reusable takeout packaging.  Vote. Lobby.  It matters to you and your grandchildren.  Trust the science we see playing out.  It's not a joke.  


Pop Quiz

1.   Name one problem with plastics.     Answer: They break down to microparticles that can soak up PCBs and other environmental toxins.

2.   Ok, now name another.   Answer:  We think we have gotten rid of BPA with our attention to its problems, but we find it has been replaced with other bisphenols like -F and -S.  These are all endocrine disruptors.

3.   What do those endocrine disruptors do?   Answer: We haven't found all the problems but 10,000 excess cardiovascular deaths a year, infertility, loss of hearing........have all been associated.

4.   What might be the worst thing you can do to give yourself more plastics?    Answer: well, how about heating up your restaurant carryout in a plastic container with a 9 label on it?  (Until you melt part of it away)

5.   Can you name one behavior you might do differently regarding plastics?   Answer:  _________. Do it.  


COVID Strategy Selenium

COVID-19 Strategy: Selenium


References:  Science Direct, Am Jr Clinical Nutrition, Wikipedia, Health Ambition, Uckele Health, Advances in Nutrition, Lancet, Nutrients, Archives Int Med, Medical News


LIttle things sometimes turn out to be really big.  You haven't heard of selenium very much as it's a pretty arcane little niche of medicine.  There are about 25 selenoproteins in humans.  Five of them play a pivotal role in making glutathione.  Many of us take some selenium to make sure our thyroids can make T3 properly and the enzyme "deiodinase", a selenoprotein,  is critical to that function.  Selenium is a tiny atom, and in that context binds very tightly in its chemical bonds.  That's what makes it useful in proteins to help do their enzymatic processes but also leads to vulnerability. Selenium binds heavy metals, pesticides, dioxins, PCBs, and all other sorts of gunk circulating in our polluted world.  We can't measure those things easily, but when we try we can find them and we do indeed have them all around us.  


Could you be selenium deficient?  Well, yes!  The symptoms are subtle and non-specific, but one of them is reduced immunity (hair loss, brain fog, fatigue, reproductive problems, low thyroid).  And why are you deficient?  Check the map attached here and notice that Wisconsin's soils are "very low".  The food grown around us in the midwest just doesn't contain much selenium.  Then, we have boatloads of leftover dioxins, PCBs, lead, and mercury in our environment: you are likely deficient.


And just why does this relate to COVID-19?  Did you know that selenium plays a critical role in viral immunology?  Yup!  There is a clear association between other RNA virus morbidity and selenium status.  So, let's look at China and the recent COVID-19 epidemic.  China happens to have some of the widest variations of selenium concentrations in soil (and hence local food), and hence localized selenium deficiency, in the world. Wuhan happens to be in the middle of the lowest selenium soil concentrations in China.  


Ok, now look at the relationship between selenium concentrations and COVID-19 survival in China.  The "cure rate" in Hubei Province, where Wuhan is the capital, was 13.2% compared to 40.6% in the rest of China combined.  The overall death rate was 3.0% in Hubei province, 0.6% in the rest of China combined.  Inside Hubei province is a unique town, Enshi, where selenium intake is over the top.    It happens to have a tiny niche of way too much selenium.  Their intake is over 550 mcg a day.  Their "cure rate" from COVID-19 was 36.4% compared to 13.1% for the rest of Hubein province.   The intake between the two areas was 3.13 mg/kg per day compared to .55 mg per kilo - about a 6 fold difference.  But just look at another deficient part of China, Heilongjiang Province, with low selenium and again, death rate of 2.6%, much higher than the rest of China and similar to Wuhan. 


Has this caught your fancy?  Of course.  It is preliminary but intriguing.  High selenium is also a problem and there is a dramatic U shaped curve of benefit and risk. Too much and you also get in trouble.  All we can really say is that these dramatic associations fit with the prior known role and benefit of selenium in immune status.  


WWW: What will work for me.  Well, you get a lovely dose-response supply of selenium from Brazil nuts.  Each nut has about 70-90 mcg of selenium, exceeding the 55 mcg per day considered a daily minimum need.  Four to five a week and you boost your midwest meager selenium dose and get some tasty nuts.  I bought a bag of Brazil nuts this week.  I will be munching them for the next six months.  (My problem is that I like them. I eat one, I eat 30 - so remember that case of toxicity, son.)


Pop Quiz:


1.  What is selenium?   Answer: A very small, light metal central to the enzymatic activity of about 25 proteins in humans, 5 of which are necessary to make glutathione, our natural detox agent. 

2.  How much selenium do we get in our diet?   Answer: In Wisconsin, very little.  We don't know a statewide average.  I have measured many patients and found them to be low if they aren't taking it.  I plan to measure more.

3.  What is the evidence that selenium will help COVID-19 response?   Answer: just epidemiology and associations.  Wuhan city, with low historical selenium concentrations, had 5-6 times the mortality compared to the rest of China.   Now, look at the map of US selenium concentrationsand compare the mortality we are seeing in the news to the map.  New York, Chicago, Detroit, and Boston are deficient.  Texas is doing fine, thank you very much.  

4.  What happens if I take too much?   Answer:  OOOH!  Don't.  You can get in trouble. There is a dramatic U shaped curve of risk-benefit.  

5.  How do I navigate this?   Answer: Get a blood test, when it's safe to get out.  In the meantime, take a Brazil nut or two.  You can probably safely take 200mcg pills that are widely available, 3-4 times a week. Then get a blood test. 



Novel Strategy for COVID-19: Methylene Blue

References:  Vine Health Care, Am Council on Science and Health, CBS News, Oxygen Saturation Sensor, Science Direct NAD,


Ever heard of Methylene Blue?  Possibly as a cheap party trick for making your pee look green on St. Patrick's Day.  Don't do that.  It does interfere with some other drugs that folks may be taking.  But what about COVID'19 and methylene blue.  In the frantic rush to find things that work, here is a though that is cheap, easily available, widely tested and well known.  And unstudied.  Could it work against COVID-19?


One of the known markers of severe disease with COVID-19 is an odd low oxygen level in folks that don't have a sense of being short of breath.  Normally your oxygen saturation is around 98-99% and you feel good.  If your saturation drops to 92-93% quickly, you feel awful.  Folks with COVID-19 show up with oxygen saturations of 70-80%, and look fine.  Something is dramatically remiss.  In fact, it appears this is a marker of future risk, walking around for days with very low oxygen saturation and not feeling it.  It is something you can measure yourself at home with an inexpensive oxygen saturation sensor.  What's going on?


The virus is thought to attack the hemoglobin molecule and damage the heme part of it, where iron is attached.  Iron is a very toxic compound when let loose.  It is tightly bound to hemoglobin where it binds oxygen in the lungs, drops it off in the tissue where it then binds carbon dioxide.  In that process it switches back and forth between it's Fe+2 state and its Fe+3 state. A pulse oximetry device measures oxygenated vs deoxygenated blood indirectly, while PaO2 (the partial gas pressure of oxygen) is measured with an arterial blood gas.  Damaged hemoglobin syndromes such as sulfhemoglobinemia, methemoglobinemia and carbon monoxide poisoning cause a low oxygen saturation on pulse oximetry with a normal PaO2, just like COVID-19.   This is called a saturation gap.  Like the London subway, "Mind the Gap".  This is called an acquired methemoglobinemia and can be the result of medication or toxin exposures which cause iron to flip from the Fe2+ (ferrous) state, where it can carry oxygen to the Fe3+ (ferric) state. where it can't.   If the percentage of methemoglobinemia is elevated enough, the patient becomes “functionally anemic” and feels short of breath.


That's where methylene blue comes in.  We referred to nicotinamide riboside in a prior posting as a possible helpful adjunct in COVID because of its NAD link.  Follow me here.  There is an enzyme called cytochrome-b5 reductase utilizes NADH formed during glycolysis to reduce methemoglobin back to functional hemoglobin.  This pathway is not normally used in baseline human physiology.  But it's there.  Methylene blue is an electron donor which can be taken orally or administered intravenously.  It upregulates the restoration of met-hemoglobin through the NADPH-MetHb pathway back to functional hemoglobin.  High dose IV vitamin C does the same thing.  Not as efficiently.  But that may be where IV Vitamin C has some benefit.  


Has this been studied in COVID-19?  No!!!  It is just known to work in other situations where you have this "Gap" and it is a way of addressing it.  "Mind the Gap".   Is methylene blue dangerous?  Well, most of the time not really unless you are G6PD deficient or on some antidepressants.  Can you buy it?  Well, yes.  It's on Amazon at 1% concentration and is what Frat Parties do to freak out folks with the resultant green pee.

I think this is a very interesting concept.  It has not been studied.  None of us should go out and buy it and start taking it.  The purpose of this blog is to spark curiosity and initiate a conversation.  We are all in a frantic global rush to explore and consider new ideas.   But the saturation gap is there.  Every ER doctor knows about it. And the first thing you will have done when you go to an ER is have your finger placed in a saturation pulse oximetry device.  And THAT is something you can do, at home.  


WWW.What will work for me?   I have a pulse oximetry device.  I just checked mine.  At age 70 it's not unusual to putz along at 96-97.  I was 98% so I'm quite happy with myself.  I did take my nicotinomide riboside this morning.  That is something else you can do.   


Pop Quiz

1.  What does methylene blue do?  Answer: it restores a broken hemoglobin molecule that has had carbon monoxide abnormally attached to it, making it impossible to transport oxygen.  If you are carbon monoxide poisoned.  Not common.  But curiously we are seeing a similar thing happen in COVID-19.

2.   What is that curious thing we are seeing in COVID-19?     Answer: Folks walking around with very low oxygen levels as measured by pulse oximetry meters.  Instead of 97-99 levels, which are normal,. folks will have 70-80s and feel fine, supposedly.   Very odd and quite remarkable.

3.   Do I have to go to an ER to measure that?    Answer:   No, you can buy one at home.  The price has gone up dramatically in the last three weeks, so buy one now before it doubles again.  Or buy 10,000 and double the price yourself (and get yourself a paid vacation by Uncle Sam for price gouging.).

4.   Methylene blue has been shown to help folks with COVID-19.     Answer:  No, it hasn 't.  It just fits the bill if you understand the physiology.

5.   What happens to the color of your pee if you take it orally?       Answer:  Irish green.  If you don't get sick from it by having a reaction.  So don't do it, yet.  

Novel Strategies for COVID-19: Plasma Transfusion

References: Frontiers Immunology, Sahlgrenska Academy, Jr Clinical Investigation, Mole Cellular Immunology, Immune Aging, Hematology


When you were born, your immune system was a clean slate.  It had no antibodies, no T cells, no memory B cells, nada.  But you had a secret weapon: a full dose of Mom's antibodies.  Newborns don't get sick for about 5-6 months as they coast on Mom's protection.  As those antibodies fade away, newborns gradually start getting little fevers and colds.  The average baby gets some 14-16 fevers in the twelve-month period of age 6-18 months.  Many of those fevers are real doozies with temps of 104, but the baby otherwise looks just fine.  A fever before 6 months is concerning!  That's how important memory antibodies are.

COVID-19 is a new virus to humans.  Hence the term "novel".  None of us have antibodies to it, and apparently the antibodies we have to other carona viruses that cause common colds just don't overlap enough to provide protection.  When we get a new virus, we are like newborns.  We get a robust immune response and make a robust fever.  IF, we have a competent immune system. IF.   Newborns have a huge thymus gland that mediates and directs the ballet of competent immune response to the tidal wave of new infections that the new baby has to navigate.   Guess what happens if you take out the thymus gland (like when you have to save a baby's life with open-heart surgery)?  Follow those kids until age 18 and their immune function at 18 is on par with a 70-year-old.  Without a thymus, they are in trouble.  Guess what happens to us as we age?  You got it.  Our immune competency plummets.  So, who is getting sick with COVID-19?  Old foggies.  You and me.  Over 40 starts the deadly climb.  By the 60s, men are reaching 10% mortality and 80-year-olds get into the 20% range.  Throw in something to damage your immune function and you can double your risk.  Diabetes is an inflammatory disease with huge amounts of inflammatory cytokines being put out by excess fat tissue.  Lack of Vitamin D makes it worse as D allows the maturation of stem cells to mature cells.  African Americans have skin pigment, blocking the natural production of D.  African Americans living up north in northern cities have even less D, and subsequently worse immune function.  Who is dying from COVID-19?  Vulnerable African American men living in Detroit and Milwaukee.  And finally, men don't age as gracefully as women.  Bummer. 

What's the plasma deal?  Well, harken back to your childhood.  Were you ever given a tetanus shot with horse serum?  I was.  Twice.  The first one was as a 10-year-old and I got a dose of horse serum.  Not the DPT toxoid you get today. That is the tetanus bacteria protein that gives your body specific antigens to make antibodies to.  No, the horse serum was an idea of collecting tetanus immune globulins from horses and then giving them to humans.  Guess what a human does in response to horse immune globulin?  You got it.  You make antibodies to the "horse".   You get away with it once.  Second time, not so lucky.  Your immune system makes antibodies to the horse proteins.  I got very ill and had serum sickness with hives all over my body.  That strategy is called "passive immunity" and was not really successful as there were many cases of serum sickness.  You want active immunity.  You want to make your own antibodies.

What happens if you don't have time?  Is there a situation in which "passive immunity" with someone else's antibodies helps?  Probably yes! Right now, with COVID-19.  What do those antibodies do?  The antibodies help reawaken old plasma cells that remember the prior infection. If you don't have antibodies from a prior infection, what do they do?  What role does passive immunization have?  Well, we don't know for sure but it appears to buy a little bit of time.  It creates the template of antibody-antigen off which your immune system gets a faster start.  And you inactivate some of the virus.  It appears to work.

What do we know and how can it work?  The Chinese did it with some success.   New York hospitals have been doing it with an emergency research approval.  The Mayo Clinic has jumped in to help mediate plasma donors with recipients.  UW has done it in Madison.  Unfortunately, we are starting backwards.  We are giving it to super sick people as a last resort. That's not when it works.  Those folks have overwhelming viral loads.  You can't turn it off easily.  You want to really use it with folks at the very, very beginning.  But that is what research is all about, finding out when it works best.  

So, here are the three or four key strategies to boost your immune response against COVID, right now.

a). Make sure you are on Vitamin D.  If you haven't been taking it, take 100,000 IU today, then 5,000 a day thereafter.  If you are African American, Asian or anyone with some pigment in your skin, take 100,000 IU two days in a row.

b). Stimulate stem cells with a fast mimicking diet of 5 days, 800 calories.  The best way to reboot your immune system and get a 600% boost in stem cells.  Nothing else does that.  (Do it every month if you really want optimal results)

c). Lose weight.  No excuses. Get your average blood sugar down. As fast as possible.  You want to live?  Do it.  

d). Consider Thymosin A administration.  Reboot your immune response to viruses. It's the peptide infants make in abundance and 60 year olds don't make at all.  Thymosin A has been proven to cure chronic hepatitis B.  Nothing else does that.  You can buy it!   

e). Plan to get someone who will give you their plasma if you get sick.  Has to be the same blood type.  And plan to share yours if you get sick.  Until we have a vaccine, this may be our best shot.


WWW: What will work for me.  I'm taking my D.  I'm on Thymosin A.  Next week I do my 5 days fast.  I've ordered antibody testing kits - and am waiting.  Hope the place I ordered them from isn't a post office box in the Caymen Islands.  


Pop Quiz

1.   Getting someone else's antibodies works to slow COVID-19?    Answer:  Well, not proven by our standard of scientific study but comes along with over 100 years of clinical use of serum treatment.  It's the top of the list of hopeful treatments until a vaccine gets here. 

2.   What type of immunity do we call giving someone else's antibodies?   Answer:  Passive immunity.

3.   Do you get any protection with passive immunity?   Answer:  Yes, you slow down the spiraling tornado of unbridled immune reaction long enough to give your own immune system a chance to make its own antibodies, if you give enough, early enough.   Works better is you start early.  Be prepared to volunteer to get it early.  

4.   How long does your immunity to COVID last?   Answer:  The common cold form of COVID antibodies appear to last only about 40 weeks.  Not very robust.  Crafty little virus.  We haven't had COVID-19 around long enough to know. Stay tuned.

5.  What can you do to protect yourself?   Answer: Wash your hands, don't touch your face, sneeze into your elbow, wash your hands, stand 6 feet away.  Wear masks in public.  Lose weight.  Take D.  Fast.  Thymosin A. Did I mention wash your hands?

Novel Strategies for COVID-19: Hit Back with Vitamins C and D

References: RealClearPolitics,  WayBackMachine, The Lancet, ProceedNatAcadSci , ClinGov, New York Post, ChildrensHealthDefense, BMJ, EndocrineConnections, Future Microbiology


COVID-19 does NOT CAUSE ARDS (acute respiratory distress syndrome).  It looks like it but that's not what is happening primarily. ARDS is happening but that is secondary and comes from too much oxygen by ventilators. Listen to Dr. Kyle-Sidell, an intensivist in New York, explain that his COVID patients are like people in an airplane at 35,000 feet with no oxygen.  You can carry a tiny amount of oxygen in your blood, raised by high-pressure oxygen.  But a more efficient method might be hyperbaric treatment.  With that, you can live without hemoglobin.  For how long?  And you think we have a shortage of ventilators.  Try hyperbaric machines


We are learning the pathology of COVID. It's more subtle and malicious. It's really more like carbon monoxide poisoning. Your blood can't carry any oxygen because the hemoglobin is being destroyed.  You die, one organ at a time as oxygen just runs out.  This blog is not fact-checked and the author is on a bit of a rant, but the key idea fits. COVID attacks the hemoglobin molecule and releases the iron safely tucked inside. Without iron inside of the heme moiety of hemoglobin, your blood can't carry oxygen.  Carbon monoxide does that too.  


Freed up iron in your blood is a terribly active oxidant that will wreak havoc everywhere. So your serum ferritin shoots up, a reliable emerging marker of COVID severity. Now, chloroquine works on malaria because the plasmodium of malaria feasts on the hemoglobin of red cells. Mess up the process by which a parasite (malaria) ruins hemoglobin with hydroxychloroquine and it's not so far-fetched to understand that that strategy may oddly work against a virus. This isn't working through antibiotic mechanisms that block internal enzymes in a bacteria, but rather may be binding directly to the hemoglobin and acting as a shield. That may be enough. (Complete conjecture on my part, as a hypothesis.). But its a mechanism outside the known working mechanisms of antibiotics so it appears to beg authenticity, but in fact might be just the ticket.  Dr Fauci is right, though.  Confirm with data.


How do you ameliorate the toxicity of free iron? Antioxidants. Lots of them. Vitamin C is simple and easy to take. Do it. One study from China showed that one intensivist was giving high-dose IV Vitamin C to his patients and appeared to have enough success to merit a randomized trial to be registered. In the pell-mell rush to study new ideas, some New York hospitals are using Vitamin C with variable success.  Results pending. 


Is Vitamin C harmful? Hardly. Should you be on it now? Certainly. Are there others that work?  Of course. That may be which NAC appears to help with COVID-19.  It appears to boost your natural glutathione which you have boatloads of as a 10 years old, enough when you are 20, some when you are 50 but none by 60.  Take NAC too.  N-acetyl cysteine, 600 mg a day.  And eat spices.  All spices.  Eat curry. 


Ok, how about D?  This is equally interesting.  This might be exactly why the African American community is having a tougher time with COVID.  You can't fight viruses without a D level above 32.  You simply don't make any cathelicidin (your natural antibiotic) below that.  I've personally tested over 500 Milwaukee African Americans D levels when I was in the ER ten years ago.  The average level would be 5-16.  Caucasians would be 25-45.  African Americans need six times the amount of sunlight to make the same amount of D in their skin because their pigment blocks UV rays.   Hence their D is lower.  We gave free Vitamin D to 3000 employees of our hospital during the last flu epidemic and had a 10% reduction in sick time called in while every other hospital had an average of 15% increase.  It wasn't randomized or approved by the IRB.  It was a gesture of goodwill.  But the benefits were clear.  Influenza goes crazy and becomes active in the fall, as Vitamin D levels drop.  Milwaukee and Detroit are two northern cities (less bright sunlight) with large African American communities.  No wonder they are COVID hot spots.  (There are other reasons too, but this one is actionable today.)


Multiple studies of D, and metaanalyses, show a reduction in ICU time , reduction in respiratory illnesses, ventilator time, on and on.  The benefits appear to be there with once a month dosing, but there is a consistent tilt in all the studies towards better results with daily dosing.  


WWW:   What will work for me.  I take 5000 IU of D daily. I'm over 60 and one's skin just doesn't make as much D as you age. I'll be taking 5,000 IU daily for the duration.  Vitamin C.  I'll all in.  I found it sold out on Amazon the first time I looked so I found another form of it. The word is out.  Join me.  This is something you can do.  And give a bottle of D to an African American.

 

Pop Quiz

1.   The mechanism of COVID on your lungs is primarily damage to lung cells by the virus.  T or F.   Answer: False.  It appears to be the inability of blood to carry oxygen.  The lung gets damaged secondarily by the use of high dose oxygen on ventilators trying to push some oxygen into the blood. One theory that explains it is that the virus attaches to and strips hemoglobin of its iron.

2. How does Vitamin C help? Answer: It is an antioxidant that calms the tornado of loose iron.

3. Would IV Vitamin C be better? Answer: One little study from China says yes. But, as with everything else, confirmation with randomized trials pending.

4. Taking Vitamin D boosts what? Answer: Your natural antibiotic called cathelicidin. You don't make any when your blood level of D is below 32. Almost all African Americans are below 20 unless they take a supplement because the pigment in their skin blocks the UVB rays that make Vitamin D. Caucasians are below 32 for the months of November-April, otherwise known is flu season.

5. Should you take D every day or once a month? Answer: both work but daily is better. But it you can't remember, just taking it matters. 

==========


Have an idea for next week? [Write us!](mailto:info@livelongmd.com)

Covid Strategy: Hit back with NAD

References: New York Times, Foreign Policy , Bloomberg, NBCNews, ScienceDirect, RejuvenationResearch, Linus Pauling Institute, Cell Life Sci, [Genes and Development, Preprints, BioRxiv, Nature

 

All right, you are staying home. (Not everyone is! See Cell Phone Tracking. And you are thinking about face masks. (You should, that is a central tenant of Taiwan's world-class control action.). You even heard of getting TB vaccination (called BCG) as a means of boosting your immune system, like they are trying in Germany. And yes, you are determined to have your ferritin monitored if you get sick. It indicates a cytokine storm is brewing and you are about to get a lot sicker. Ask for tocilizumab, and turn it off early.


But I want to get to the heart of a new idea you can implement yourself. Your energy. One of the cardinal symptoms of the COVID-19 is extreme fatigue. I mean, extreme. Just a little more and you're dead. Yeah, loss of smell early, dry cough, fever, and chills, muscle aches are all in there too. Then pneumonia and organ failure. But without energy, you're done. And now we know why. 


Let me introduce NADH Niacin, Vitamin B3 is its source. It is smack dab in the middle of energy production. You can't make your internal fuel, ATP, in your mitochondria without NADH. Virus infections highjack NADH production and deplete it. Getting older and it gets a little shakier too. Then viral infections are harder on you. And that appears to be front and center of the COVID-19 problem. At age 69, I have about a 10% mortality chance, boosted higher by being male. Is it my NADH deficit? We know NAD plays a key role in your innate immune response to viruses. So it's not unexpected to see the article published just this week about COVID-19 depleting NAD and that being central to its pathology. All metabolic paths of COVID-19 end up with NAD depletion.


Can you fix it? Yup! In the last few years, we have realized that taking Niacin is a pain. Too much flushing. We have tried it for everything because NAD is so important to our health. You can't get people to take that flushing. But if you add the "riboside" form to it, it works! No flush. Good blood levels


Clinical results? This is moving too fast. Pending. But is NAD-riboside dangerous. Nope. GRAS - generally recognized as safe. Niacin without the flush.


WWW: What will work for me. Well, I bought some off Amazon. First time I looked it was there. Next time, it might be sold out. There is a fancy brand name but a bunch of companies make it. For now, it might be worth the branded name. I intend to take it till all this craziness is over. Meantime, I'm practicing spelling [tocilizumab so I can ask for it](https://www.nytimes.com/2020/04/01/health/coronavirus-cytokine-storm-immune-system.html) by name.


Pop Quiz

1. The heart of viral infections is what? Answer: they downregulate your energy production via NAD to highjack it to make their own reproduction.  

2. That has been proven with COVID-19. T or F. Answer: True

3. As you get older, you make less NAD. T or F. Answer: Sadly, true

4. You can safely raise your own NAD levels by taking what? Answer: Take nicotinamide riboside, 300 mg or more

5. Should I wear a mask in public? Answer: For heavens sakes, yes. The countries that have succeeded do it. We can. My guess is much more is spread by insignificant aerosolization of saliva that we realize. Small droplets that happen when you [sing](https://www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak), [talk](https://www.medscape.com/viewarticle/928149), breath deeply, cough and sneeze. Cough and sneeze get all the attention but explain to me how it spreads so fast short of those. We make fewer droplets when we just talk, [but we still do](https://www.medscape.com/viewarticle/928149). And that's why masks work. You go for a walk and a 21-year-old jogger runs by, breathing hard. You’re done without a mask. At least worse odds.


Have an idea for next week? Write us! 

COVID-19 Strategy - Your Microwave!

References:CDC, Galvaston News, Consumer Reports, Post and Courier, Quora, JAMA,BioRxiv


Can I get carryout? Can I help keep our restaurants alive? Is it safe to order from all the places that say they are hands free?


We don't know for sure. We can't be certain that the chain of humans from cooks, to packaging, to delivery to you are perfectly clean and virus free. We do know that the virus can last on surfaces for 48 hours at least. We don't know if the food source has its employees wearing masks or being tested for safety because we have no testing yet at the site of food preparation. It is likely aerosolized in microparticles leading WHO to "thinking" of making airborne precautions - which ramps up dramatically the risk for health workers and increases the demand from PPEs (personal protective equipment). Airborne would explain the rapid spread in dense cities. Just imagine a New York subway and one sneeze or cough. Six feet encompasses 12 people. Considering that the early mathematical models from China suggested each case passed it on to 2.2 people, we now see how it spreads. But what about food that is put into a sterile container while hot and then given into a transport bag that has no human contact that is then delivered to you?


Searching around

The CDC claims that we have very little evidence that the virus is spread by items imported into your home. Carryout! How can you make sure it's safe? Well, the CDC says anything above 167 kills viruses. Boiling is 212 and Pizza ovens are 450 or higher. Can you use that knowledge to make your food safe? Sure you can. You can reheat your purchased food items to get them back up to almost boiling. That won't work with salads and cold items, but it sure will with hot food. God forbid I endorse pizza but it is cooked at a very high temperature, making it sterile, at least when it comes out of the oven. Can you make sure you get it hot again, and then don't burn the top of your mouth?


We do know that the microwave will likely not be good for your newspaper. There are studies showing that you may burn it up, with cash also being at risk.


WWW: What Will Work for Me? We haven't ordered carryout from all the restaurants crying for our business. I plan to. If we don't help our businesses that are affected by this terrible pandemic, we won't have them when it is over, a year from now when the vaccine is available. I wash my hands after anything brought into our home. I try not to touch my face, rub my eye, sneeze or cough without cover. But for me, one restaurant meal a week, with a tip, and wash my hands, wash my hands, wash my hands. Don't get closer than 6 feet except for the 3 seconds it takes to pass off the meal.


Pop Quiz

  1. COVID-19 is spread primarily through what? Answer: Respiratory droplets that get on surfaces or are breathed in by people close to the source. Patients with COVID-19 have had viable virus found on their airvents (at least the RNA, not by viral culture) that could have been 48 hours old.
  2. Items brought into your home can carry the virus. T or F. Answer: True but not the common or main source by far. The virus lasts on surfaces for up to 48 hours, but it then has to get to your face and its mucous membranes. It does not burrow through intact skin. Spend more time washing your hands, less time washing your counters. (Still clean your counters, just wash your hands more)
  3. What temperature destroys the virus? Answer: 167 degrees.
  4. Will your microwave clean your money? Answer: Possibly but it may also destroy it and maybe catch fire. Dry surfaces aren't likely good for the virus.
  5. Can a microwave help you in this epidemic? Answer: Yes, it can heat food you order from a restaurant back up to 170 or higher and thereby sterilize it.
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Wash your hands. The COVID virus lasts for 17 days on surfaces. The Princess Cruise ship proved that. Washing your hands and not touching your face might be more important than every.

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