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.

Novel Ideas to Combat COVID-19: Potassium, Melatonin and the Alkaline Diet

Novel Ideas to Combat COVID-19: Potassium, Melatonin and the Alkaline Diet

References: MedRxIVArchives of VirologyJr Envir Public HeatlhJr of Bone and Mineral Research,

Want an idea that you can do to keep yourself healthy and prepared for when COVI-19 gets to you? Yes, you have self-isolated. No, you haven't gone to the grocery store and have started getting pick up instead. You only saw 4 people yesterday and didn't shake any hands. You washed your hands 4 times yesterday to boot. And you didn't touch your face at the average rate of 19 times an hour. 
What else? Yes, you are taking 5,000 IU a day of Vitamin D and 25 mg of zinc. Yes, you are at home practicing guitar and watching Netflix. No, I don't want to hear you playing John Davidson songs.

So, this study from China about potassium caught my eye. Almost every patient with COVID in China was noted to be hypokalemic, low on potassium. The thought is that COVID-19 attacks the cells in your kidneys that excrete potassium, and you can reverse that with ACD-inhibitors. Hmmmm.

Let's just review what has happened with potassium in America in the last 200 years. We used to eat more potassium, much more. The ratio of potassium to sodium used to be 8 to 1. Now it's one to three or four. That's a 24 fold shift and reversal of the ratio. But due to the ions that travel with potassium and sodium, it's also a reversal of pH. When you are potassium dominant, for complex metabolic reasons, your urinary pH will be 8, alkaline. When you are sodium dominant, your urinary pH will be 5.5, acid. Did you know that some viruses multiple as much as 1,000 fold faster in acid pH? Is that all viruses? It hasn't been studied and we have no clinical proof whatsoever. All we have is the observation that COVID patients are low in potassium. Does replacing potassium ahead of time help? We don't know. Is there any harm to doing it? None. What happens if you eat an alkaline diet? We know for a fact that potassium citrate alkalizes your urine, increases your intake of potassium and improves calcium balance, thus protecting your bones. We know that if you eat nothing but vegetables, your urine will be naturally alkaline. Will increasing your potassium balance make you ready for COVID-19? It has no harm unless you are on drugs that block potassium excretion, like ace-inhibitors. 
How about melatonin? Well, here again, we have to get to how viruses become deadly. If your immune system has never seen a particular viral antigen, it ramps up to fight it. Your innate immune system has a ramping up, and a calming down process. If you don't have prior exposure and no immune memory, your ramping up spirals out of control into a "cytokine storm". Here is the fascinating nugget. Melatonin acts as a brake on cytokine storms. You make lots of melatonin when you are young. By age 40 your melatonin production starts to degrade badly. By 60 and 70 you are making virtually none. One-year-olds have a melatonin of 325 pg/ml. Seventy-year-olds peak at 25 pg. Who is getting sick and dying with COVID? Melatonin turns off that cytokine storm. Pregnant women in their third trimester of pregnancy triple their blood level of melatonin. Do you find it interesting that there have been no victims of COVID-19 who are pregnant? Hmmm. Want some melatonin? Again, it's harmless. Dose? Start with 1 mg. Ramp up to 3, or 5, or 10. At bedtime.

WWW: What will work for me. These are simple things you can do to prepare your body for the assault of COVID. Eat lots of vegetables that are steamed so they still have their potassium and magnesium. Consider taking some potassium citrate to alkalize yourself. The OTC potassium citrate is 1 meq per pill so you have to take a lot of them. You can buy it in bulk and make your own capsules. A 00 capsule will hold 10 meq. A great little machine can be purchased at Swanson. (The research on bones was with 60 meq per day, which is what I'm taking myself and have had no increase in blood potassium levels. But prolonged potassium in folks with renal failure or some meds may accumulate and should be monitored.). Take melatonin at bedtime. Some folks get drowsy at 1 mg a day, or 3, or 5 or 10. I personally take 10. If I'm in the hospital, I want Holly to smuggle in melatonin. But we are all in this together. Don't forget to wash your hands and stay 6 feet away. Cut your boxes up and dispose of your grocery bags immediately on bringing home, then wash your hands before you touch your face.

Pop Quiz

  1.  An observational study showing that those who die of COVID in China, all have low potassium, means supplementing with potassium will prevent death from COVID-19. T or F. Answer: No proof at all. Loose, tangential association. But may be true. No time to study right now and no harm in trying, unless you are on potassium-sparing drugs or have renal failure.
  2. Do we eat enough potassium compared to historical records? T or F. Answer: Pants on fire false. Our intake of potassium has plummeted. Every membrane in your body depends on sufficient potassium.
  3. Viruses multiple better in an acid medium? T or F. Answer: Only one study on it from 40 years ago but an intriguing idea. Our diet has also become acidic because we eat many more animal products.
  4. Melatonin is naturally what? Answer: Discovered as your "sleep" hormone, it is also a very potent anti-cancer drug, and a very potent modulator of the "cytokine storm" tornado your immune system makes in those viral infections that kill people quickly with multi-organ failure and respiratory distress syndrome (ARDS). That's what all the ventilator talk is about.
  5. A seventy-year-old makes just as much melatonin as a 1-year-old. T or F. Answer: Pants on fire false. Ratio of 25 to 350, less than 10%. Good news, you can take it orally and it's cheap. Do it!
COVID-19 Virus Action List: What You Should Do, When

References: CNN HealthSTAT NewsCDC Pandemic PlanNew York TimesOurWorldInData,

Ok, here is the best data we have now. And a list of what you should do when. Yes, COVID-19 is a big deal. The 1919 Influenza killed 2.5 people per 100, resulting in 675,000 American deaths. The regular seasonal flu kills about 1 in 1,000, for reference. Regular flu kills by setting off pneumonia or heart attacks. COVID-19 causes a cytokine storm and ARDS (acute respiratory distress syndrome, requiring a ventilator). So, it is about 10-20 times more dangerous. Stop the silly argument, "30,000 people a year die of regular flu." We are going to get there, and much more if we don't act. 
So, what are your risks? Actually, it all depends on your age and gender. Young kids, no big deal. Very low attack rate in children. Up till age 50, your risk is probably less than 1%. In China, the CDC found that only 0.9% of cases were under age 9 and even fewer deaths. In your 60s. you are likely in the 4-6 % range. Seventies are 8%. But over age 80, it's 14.8%. By contrast, the fatality rate was 1.3% in 50-somethings, 0.4% in 40-somethings, and 0.2% in people 10 to 39. Gender has bias too! It's only 1.7% death rate overall for women and 2.8% for men, China CDC reported. 
So: it's bad and it's going to get worse. It is being spread by asymptomatic people so avoiding sick folks wont do it. We have to do a higher level of battle, and that depends on testing. Short of that, consider these steps: 
NOW 
1. Practice washing your hands: soap and water, 3 times a day and every time you come in from outside. Just start doing it.

2. Don't touch your face or pick your nose. Don't rub your eye. Get a tissue. Rubbing your eye is a particularly good way to introduce viruses into your tears, and then into your nose. 
3. Avoid crowded places with people from far away. Planes, sports venues, malls, movie theaters. Social Distance: At least 3 feet, 6 is better. Elbow bumps are cool.

4. Wipe and Clean. Get a package of alcohol wipes and carry it in your car. Wipe the gas pump before you use it. Wipe your home doorknob before you use it.

5. Shop for food at 8 am Sunday morning, Monday morning. Check yourself out. Wipe yourself down.

NEXT: 
6. Get creative about your work. Consider working from home. 
7. Limit your excursions out of your home. This is going to last a year until we get a vaccine. The thought that we will have it over in a month is probably unrealistic. 
8. "Snow Days" when everyone stays in on lockdown - works if you go for 2 cycles. 10 days. Hard to maintain.

9. You need to hang on to your will power and your soul. This is a terribly frightening journey into darkness. We need to do battle with your darkness. Keep in touch with loved ones. Skype. Talk. Visit (a little) folks you know who are safe.. 

10. Support the organizations you love. Your church, your theatre group, your zoo, your sports team. Stay connected and give them support. They are more desperate than you.

THEN (Maybe soon - we are rising quickly still.) 
11. Shutdown. Do you have three months of food? Soap. Toilet paper.

WWW: What will work for me. I'm reading everything I can get hold of. I welcome your suggestions. I intend to add to this list and would welcome any thought you may have. I've subscribed to a newsletter you may like. The CovOdessy.com by Ryan Hagan - academic epidemiologist who studies pandemic diseases. I'm buying Thymosin A for myself for home injections. I'm walking every day and eating tons of vegetables.

Pop Quiz

  1. Ok, if you read Ryan Hagan's newsletter you would see that mortality reports doubling every __?__ days. Answer: 3
  2. And in that same newsletter, how many Americans will die according to a leaked report to the American Hosptial Association? Answer: Over 400,000
  3. The 1918 flu virus killed how many per 100? Answer: 2.5. The annual regular flu in America kills about 0.1%, so roughly 1/20th as bad. Today: 14 % for 80-year-olds.
  4. If you are over 80, what is your risk of death if you get it? Answer: 14.8%. 8% if you are in your 70s. 6% in your 60s.
  5. This virus is going to calm down over the summer. T or F. Answer: We don't know for sure but Australia is in summer and they are getting it. Singapore got it.
Do I Need to be Tested for the MTHFR Gene?

References: Translational PsychiatryCleveland ClinicCell Science SystemsJr of Alzheimer's DiseaseAging85% SolutionScience Based Medicine,

Want a really good Halloween Buggyman? Dress up as the MTHFR Gene and pretend to cause autism, depression, and just about everything else modern civilization has to offer as wicked diseases. With the advent of the human genome project, we now can measure many many genetic variations in gene activity and function. The question arises, do those variations correlate with meaningful clinical outcomes? I have people coming to me on a weekly basis asking that question. What is the rational science behind this and what should you do? 
It is possible to measure two genes, C677T and A1298T, that are present in some 30-50% of various populations. You get two of each, one from each parent so having a "defective" one means you don't regenerate methyl-folate from folic acid as effectively as some folks. If you have two crummy copies, you regenerate even less. The net effect is that your ability to pass on methyl groups to various chemical processes is reduced. Methyl groups are used to tag DNA as a marker for genetic expression. They are also used to help get rid of cellular garbage by making it water-soluble so you can pee it out. Most notably, you get rid of neurotransmitters more efficiently, ostensibly. Does it matter? 
These type of findings have led to a raft of "associations" between the genetic markers and various psychiatric conditions, from autism to schizophrenia and depression. Depending on how you lean, you can find review articles that support the premise that this is truth orthis is bogus. The problem is is that associations aren't proof, particularly when the "defective" gene is so common that 40% of the population has it. 
Is there reality to any of this? Well yes! If you have really low genetic function of MTHFR genes you can have very high homocysteine levels in your blood. Homocysteine is the carrier of methyl groups that passes the methyl group on to glutathione. There is a strong connection between Alzheimer's and homocysteine. An international consensus statement wasissued in this regardBredesen considers the management of homocysteine as one of the keys to Alzheimer's prevention, in part because it is so easy to take extra B12 and methyl-folate and homocysteine is so easy to lower. His goal is to get your homocysteine down to 7. The average American is roughly around 12 or so, so that is a clear marker. 
But does it cause other diseases? Based on all sorts of anecdotal stories, there are advocates for the MTHFR genes causing all sorts of problems. Dan Purser in his book the85% Solution goes into great detail on the topic. He claims half of America is sick with it and if you just follow his program, you will be much improved.

The voice of modern, traditional medicine isn't there yet. Virtually every standard health site like the Cleveland Clinic and Science Based Medicine put the kabash on MTHFR testing and suggest you settle for taking some extra B vitamins and using homocysteine as your marker of success.

WWW: What will work for me. Goodness. I've read every MTHFR book, listened to on-line leactures, gone to conferences, made up talks about MTHRF and measured it for about 10 years. I've come to the conclusion that we just aren't there yet. I believe it's real with Alzheimer's and heart disease but it is just not worth the anxiety and stress of getting the genetic testing. I tend to reduce the supplement bills of a lot of my clients who have come from other doctors who have plied them them with boxes full of expensive cure-alls. Just measure your homocysteine. If you are above 9, you definitely need to do something. Homocysteine Resist is one of the least expensive, most effective supplments that will do a dandy job of lowering your homocysteine. And I need to get rid of my double helix Halloween outfit. It's just not scary enough.

Pop Quiz

  1. What is MTHFR? Answer: Methylenetetrahydrofolate reductate
  2. Aside from being a spelling-bee question, what is it for? Answer: it is a protein that regenerates methyl folate, a useful "methyl" donor, from simple folic acid. There are two common genetic variants of it that some 30-40% of the population has that result in slower regneration of methyl folate. 
  3. What do you use methyl-folate for? Answer: to pass on methyl groups so that you can tag DNA, ged rid of neurotransmitters that have been used and get rid of gunk, must notably heavy metals.
  4. Are these MTHFR mutations a cause of disease? Answer: Ah, there is the rub. Lots of controversy. Probably likely connected to Alzheimer's and heart disease but just not proven for others. Claimed to be much more important by some authors, but those authors tend to be high on the "quack" lists of watchdog groups.
  5. What can you do? Answer: Simple. Measure your homocysteine. It is a marker of effective production of methylation. Take Homocysteine Resist, a product from Life Extension that has extra methyl-B12 and methyl-folate that both help rev up MTHFR and lower homocysteine. Make it easy. But do take it for the rest of your life. But don't get the MTHFR gene test. Just don't.  Run if someone offers.
Want to Avoid Corona Virus? Strategize Now

References: WHO AdviceNPRConsumer ReportsFrontiers in AgingLive ScienceJr Clinical Exp Pharm,

Lots of chatter out there about how to prevent your risk of COVID-19! Don't travel to Wuhan, or China for that matter. As of right now, (Feb 17, 2020) it appears to be slowing a bit, albeit having reached a higher death total than SARS. Keep your fingers crossed that this is the beginning of good news and public health measures are working. Or not! Time will tell. 
So, what does WHO tell us to do? Wash your hands and use hand sanitizer like crazy if you can't get to a sink. That's it. Ok, I can do that. Is that it? Can't we all just wear body suits and respirators? 
Let's give you some more practical ideas. Item #1 is Zinc. Lowly little zinc. NPR did a story just this week about Dr. Prasad who conducted a randomized placebo-controlled trial on zinc and found it reduced colds by some two days. There has been some back and forth about it but a meta-analysis of zinc and colds (combing all high-quality research) came out with a net plus. Consumer Reports suggests zinc may be overrated because of its risk of side effects. Similar controversy exists around zinc and Alzheimer's which leads to the conclusion that it should be measured and monitored, and most of the time replaced. How much zinc? We think some 80-90 mg at the beginning of a cold is the magic number. But there is huge variability in people's zinc blood levels that hasn't been taken into account in the studies I've seen. One or two days of that won't hurt. We all likely should be on some extra zinc regardless for brain health, and be monitored (30-50 mg a day). Bill and Melinda Gates have been high on my hero's list for creating an international awareness and treatment of childhood diarrheas caused by rotavirus: part of which involves a 5 mg dose of zinc for babies. 
But let's get a little more innovative. Did you see the recent research on COVID-19 that it doesn't appear to affect children much? Now that's interesting. Kids are usually the town cesspool for viruses. They get everything. Why are they not showing themselves to be ill from COVID-19? Let me conjecture. Their immune systems are working well. They have boatloads of their natural virus-fighting hormones or peptides, notable Thymosin A1 (T-1). I want my immune system up to shape if COVID-19 comes to town. We all stop making the stuff (T-1) around age 40 and those of us over 40 will tell you we are sicker longer and deeper with viruses than we were when we were young. Now, T-1 is approved to help reverse chronic Hepatitis B in some 40 countries, so it is a known virus fighter.

If I get exposed to COVID-19, will T-1 help me? I bet it will. It may be the secret weapon we can use to keep ourselves well. You used to make it when you were a kid. And when you got to 40, you were pushed out into the pond without a paddle. Good luck!

WWW: What will work for me. I take zinc and monitor its levels. I wash my hands obsessively. I've also been taking T-1 before I travel and have yet to get a cold over the last year of travel. I've given it to some folks with colds and the response I've had so far is mixed. Some get better quickly and some have little effect. There are no RCTs on common colds but good research is out there with other viruses. It would make perfect sense.

Pop Quiz

1. What is the most effective way to avoid getting Coronavirus? Answer: According to WHO - Don't expose yourself to it by travel to China, if you can avoid it, and wash your hands with great sedulousness.

2. Zinc has been proven to help with two viral diseases. Which? Answer: Rotavirus in children and common colds in older adults. 
3. How much zinc? Answer: For adults, probably at least 50 mg extra a day early in a cold. Rotavirus: 5 mg.

4. What is Thymosin-a1(T-1)? Answer: The natural peptide you make when you are a young person that balances your immune system and boosts its ability to fight viruses. 
5. How do you administer T-1? Answer: Right now it's only available as a shot with a teeny insulin syringe. If you are really interested and want to know more, I'm doing it for myself so come on by.

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