“I wish it need not have happened in my time,” says Frodo. “So do I,” says Gandalf, “and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.”
Lord of The Rings, J.R.R. Tolkien
My Personal Plan
Many have asked about my personal approach. Based on the best research, past experiences, and seasonal variations I have adapted and tweaked a variety of lifestyle approaches. These have fortunately kept me healthy, especially during the seasonal periods of colds and cases of flu for many years, and I’m grateful to say that I’ve never missed a day of work due to an illness in my over 20 years as a physician.
The following is a look under my hood to share what I’m doing and have found helpful for me- it is not a recommendation for all to do- however, I’m always available to speak about general or personalized strategies to improve your Nutritional Armor and be impregnable as the city of Constantinople’s great wall of the Byzantine empire which repulsed invaders for > 1000 years!
My general principle revolves around the concept of being a Stoic Monday thru Friday so that I can be an Epicurean on the weekends.
I generally find that by the end of summer/early fall I have put some pounds on and work hard to shed weight as winter and then spring comes along. We need to lower visceral fat to improve our immune system’s response to the season of infections. Here is a graph of my body compositions from September 2019 until the end of March 2020. I track my body comp regularly and especially as I make changes in diet or exercise. As you can see, I was able to gradually drop weight and body fat over the 6 months. I still enjoyed the holidays but remained disciplined with my goals. Fasting and exercising often is associated with some muscle loss and I make many efforts to maintain an overall good amount of skeletal muscle mass. In March I was even able to gain some muscle mass despite fasting for Lent.
Rituals and Exercises:
I generally begin the day with warm lemon water (sometimes with apple cider vinegar) and some vitamins- often including some adaptogens for energy and essential amino acids (EAAs). I’m not a big coffee drinker but having black coffee and tea at this time would be fine. This is followed by some quick contemplative exercises including brief prayers and mantras, journaling or goal setting, quick and simple bodyweight exercises or stretches. I then do some dedicated cardio- either elliptical or recumbent bike usually between 20-40 minutes often followed by a jump into my portable sauna set at its max temp of 150F for at least 15-30 minutes, longer if I don’t do any cardio. I’m usually reading or listening to books during the cardio or sauna- the reading material covers a variety of topics and is great help for me to gain some wisdom, get in a sacred/grateful state, or learn resiliency from biographical sketches, and is not necessarily just about the Greeks 😊. I’m always taking lots of notes and usually WhatsApp-ing my brother at the same time. The whole process takes no more than 1 hour but at times I’m done in 20-30 minutes if pressed for time. I find cardio and sauna in a fasted state is more beneficial and aim to not eat before exercise if possible.
My exercise routine during the winter and spring when I’m trying to shed weight is generally to increase the cardio morning routine to at least 5-6 x week and cut down my resistance or bodyweight exercises to 1-2x week from about 3x weak during other times of the year-usually not more than 20-30 minutes. My resistance exercises are done at home and heavy on bodyweight movements including using my pull up bar, and other compound exercises that include a lot of pull and push exercises such as pushups, dips, shoulder presses with dumbbells, and leg exercise with squats and lunges and some jumping. Of note, I spend a good amount of time on weekends from about May through October getting plenty of sun outdoors as I do some targeted exercises or just read in the backyard, often with a shirt off to get extra sun. I have been told that I need to do more yard work though, so this plan is not without risks.
I’ve found the principles of the ancient Greco-Roman baths, Russian Banya, Turkish Hammam, Scandinavian Saunas, and Native American sweat lodges fascinating culturally and important tools of wisdom and insight for physical and spiritual health and thus constantly play around with their ideas. In addition to the portable sauna as above, I try to combine both hot and cold parts of the shower, while at the same time doing some stretching, visualization, and contemplative practices, and breathing exercises. I use this time to aggressively flush out the sinuses with Xlear- a specialized saline rinse thought to help break up bacteria and yeast, and silver nasal spray. There was someone recently claiming silver can treat COVID which we know it can’t but it has been used for years to help decontaminate areas such as the sinuses, and silver is a popular ingredient in a well-known prescription cream used by burn patients to treat infections.
I try to aggressively scrub my body with a coarse towel based on the wisdom of Steve Maxwell and in mimic of practices of the above mentioned traditional Banya and Hammam cultures. Maxwell is a renowned trainer, Brazilian Jiu-Jitsu instructor, and health coach. His philosophy and outlook are unique and always informative. I’ve linked his morning routine ritual below which I think is a good reason why he has aged so well and doesn’t look like he is in his 60s. I don’t do all of his routines but have chosen some to intermittently work with and found them of help. He really is a throwback to an old school health and fitness approach and incorporates many of the traditional cultural routines for health and vitality.
Diet:
“A man who is badly fed, cannot bear for a long time, the fatigues of prolonged labor; his strength even abandons him, and to him, rest is only loss of power.
Sure enough, carnivorous animals never grow fat (consider wolves, jackals, birds of prey, crows, etc.). Herbivorous animals do not grow fat easily, at least until age has reduced them to a state of inactivity; but they fatten very quickly as soon as they begin to be fed on potatoes, grain, or any kind of flour.” – Jean Anthelme Brillat-Savarin, 1825 French lawyer, politician, who gained fame as an epicure and gastronome, is considered one of the fathers of the low carb diet.
My diet overall varies depending on season, subscribing to but personalizing a Greek-Mediterranean twist (what I just call food) on an American omnivore approach based on what I learned from my family and tweaked with fasting roughly in line with the Church calendar throughout the year. Being married to a Lebanese girl has made it all the easier. These specific days are more plant or pescatarian-based while other days I’m more of an omnivore. Generally, I try to under-eat during the day and eat more completely at dinner at least a few days per week. I found my thin farmer build and high activity level has allowed me to have a high tolerance for carbohydrates, especially compared to more muscular build men. My typical week may include some formal Intermittent fasts or even OMAD (One Meal A Day) but not always. For the most part, I have found the wisdom and diet principles of the great Ori Hofmekler and his excellent book The Warrior Diet to be very helpful. (link to our own amazon account for this book?)
He goes through the diet and lifestyle of Greek and Roman warriors with discussions of approaches to stress and resiliency and exercise as well. The simple way of eating clean and light with frequent fasting aligns nicely with many traditional cultures and is espoused by Steve Maxwell above and also the excellent P.D. Mangan, a science writer and health coach who has a great social media presence.
Ori Hofmekler was actually the first person I’m aware of who spoke about the principle of intermittent fasting greater than 10 years ago, truly ahead of the curve and also in fabulous shape for a guy of any age. These three gentlemen appear to be in their 60s yet live with vitality and seem bulletproof with smart aging and provide more real-world health wisdom than the majority of buffed out young guys or dieticians endorsed by the medical bureaucracies.
Supplements:
I’ll link the specific supplements I take in the future but suffice it to say my current regiment is guided by my goals to replete common nutritional deficiencies, optimize my immune system, and achieve maximum energy and vitality. My winter/spring regiment has been augmented by the growing research and understanding of how to create resiliency and help the immune system as outlined below by the many links- many spanning a number of years and based on sound scientific principles.
Generally these days I have been taking:
A multivitamin and mineral pack with extra antioxidants and fish oil
Essential Amino Acids and sometimes creatine and nitric oxide support before exercise. I often will sip on the EAAs while under eating during the day.
Extra Vitamin C, zinc, vitamin D (at least 5000 IUs daily), and a quercetin mix (which I have found helpful for my allergies as well). Incidentally, the nettles in that mix have also been shown in studies to help calm an exaggerated immune response.
SPMs- special pro-resolving mediators fish oil derivatives
I take regular elderberry-often added to my strong cranberry or pomegranate juice that I water down.
More melatonin than usual to help the immune system in view of this more recent work-usually in small doses. I use a chewable that has other natural sleep support.
An antioxidant blend that has NAC (good antiviral and support for lungs), lipoic acid (recent data that the IV form may be effective against COVID), and a mushroom blend including some of the ones mentioned by Dr. Galland below. I particularly like Cordyceps for its energy and respiratory benefits. This year I’ve added the mushroom Chaga based on the probable health and immune benefits espoused by many cultures and shown in some research coupled with the significant discussions by Chinese doctors extolling its positive benefits and their belief that it may have helped their ill patients handle the Novel Coronavirus.
An adaptogen/adrenal supplement that has a blend of botanicals most notably including Rhodiola which has research to support its use for helping the respiratory system.
I rotate probiotics-taking them a few times /week.
Botanical antimicrobials like oregano and thyme I use intermittently and could use them for acute therapy in addition to higher amounts of vitamin C- which I have in both capsules and vitamin C powder- and Vitamin D.
We are working with some of our resources to put the best immune support in one bottle or pack for convenient use. We are thinking about having one combo for prevention and another one for acute support. More to follow soon.
“The microbe is nothing. The terrain is everything.” -Louis Pasteur
Louis Pasteur (1822-1895) is purported to have made this statement on his deathbed. The origin of the quote is attributed to Claude Bernard (1813-1878), a physiologist and contemporary of Pasteur. By quoting Bernard, Pasteur was recanting his germ theory, a theory that assigned the cause of disease to microbes invading and wreaking havoc on the body, with specific germs causing specific diseases.
In contrast to Pasteur, Claude Bernard, and Antoine Bechamp (1816-1908), another contemporary of Pasteur, believed disease was a condition of imbalance in the internal terrain of the body. Bernard and Bechamp emphasized the context or environment in which germs lived and not the germs themselves. On the one hand, if the terrain was balanced (homeostatic), then germs could not flourish. On the other hand, if the terrain were out of balance, then germs would thrive. In short, germs do not cause disease. Instead, they are a sign of the diseased conditions of the terrain and not the cause of those conditions.
Clearly, with the lens of hindsight and current eyewitness experiences with this formidable and novel virus, the germ theory of Bernard is alive and well. However, many- if not most- healthy people are not succumbing to the virus’ potential deathly grip. As I have been saying to all who will listen- it is not the Bubonic Plague. Perhaps, those doing well have a more balanced or homeostatic system, terms and concepts at home with Hippocrates and Galen as much as with Pasteur.
Or perhaps a better term is taken from a great Mediterranean thinker Nassim Taleb would be “anti-fragile”, an example from our present-day:
COVID-19 In The Blue Zone: What’s Helping Elders In Sardinia, Italy
Italy has the third-highest number of coronavirus infections, after the U.S. and Spain. But its ancient, isolated island of Sardinia, one of the world’s five Blue Zones (where people live the longest, healthiest lives) hasn’t been devastated by the pandemic. It appears that some of the reasons Blue Zone Sardinians are able to live vitally into their 80s, 90s, and 100s may be helping them stave off COVID-19 — and sustaining them during their country’s lockdown.
I believe from the study of research, clinical experience, and personal history, that optimizing one’s terrain and soma-psyche-pneuma (body-mind-spirit) is crucial to adapting to and surviving well in the midst of infections and unprecedented times.
Below we take a deeper dive into a variety of areas to help support one’s terrain and ecosystem.
Sleep
Thousands of years ago, Hippocrates suggested that sleep might improve recovery from illness. Yet despite this ancient observation, it is only quite recently that the link between sleep and our immune system has begun to be elucidated. A randomized trial found that subjects with less than seven hours of sleep per night were nearly three times as likely to develop a cold after being exposed to a rhinovirus, compared to those who got at least eight hours of sleep.
Diet
I’ve found this diet writeup from an unknown author to be of value and filled with common sense:
The immune system is an “organ” just as our lungs and livers are and there are things you can do to keep the immune system healthy. Certain foods do help immune health as well. Some of the best foods that support immune health are:
• Yogurt. Regular intake does result in fewer sick days. The body’s white blood cell count increases substantially and the GI tract bacterial community remains very healthy, which also helps. Kefir can also be used.
• Oats and barley. Farm animals given a mix of the two have many fewer infections, including those from influenza. (And yes, in spite of rumors to the contrary, we actually are animals, too.)
• Garlic. Although not as strong an antibiotic as I had formerly thought, regular garlic intake does boost immune function — in one study, those taking garlic were much less likely to catch colds and flu.
• Selenium-rich foods have been found to help clear influenza infections from the body. Selenium is found highest (in descending order) in Brazil nuts, fish (tuna, cod, halibut, sardines, flounder, salmon), poultry (chicken and turkey), sunflower seeds, shellfish (oysters, mussels, shrimp, clams, scallops), meat (liver, beef, lamb, pork), eggs, mushrooms, whole grains, wheat germ, onions, garlic, asparagus, broccoli, tomatoes. One ounce of Brazil nuts (usually just called “nuts” in Brazil) will supply 544 mcg of selenium — you don’t need many; one Brazil nut can supply a whole day’s supply of selenium. To give a comparison, tuna fish contains 68 mcg per ounce, cod 32 mcg per ounce, turkey 27 mcg, sunflower seeds 23, oysters 22, and so on.
• Chicken soup. Yes, it does work.
• Black tea. It significantly increases the immune system’s interferon levels. Green tea will also be of benefit.
• Zinc-containing foods. Zinc is an essential mineral, especially in immune function. It enhances the actions of many of the immune system’s actors, including T cells. Zinc is highest in oysters, wheat germ, liver, seeds (highest in sesame, tahini, pumpkin, squash, and watermelon seeds), roast beef, dark chocolate and cocoa, lamb, peanuts, garlic, chickpeas. To give you an idea of levels: Oysters concentrate zinc (and copper as well). One medium oyster contains about 13 mg of zinc, 3 ounces of wheat germ contains 17 mg, calf liver has about 12 mg per 3 ounces, sesame seeds contain about 8 mg per 3 ounces, and so on.
• Mushrooms. But not the usual store-bought variety. Shiitake and maitake can both be used in cooking, and they are both very good for raising immune function, primarily due to their high levels of polysaccharides. Their polysaccharides raise immune function considerably when taken as a regular part of the diet.
Superfoods I’ve been personally emphasizing, and in no small part because during the Lenten season I focus more deeply on plant-based dynamic foods and fish, including: sunflower and pumpkin seeds, shelled hemp seeds, ground flax seeds, lentils, and giant beans, Cretan Barley Rusks, mixed berries and especially cherries (usually frozen), carrots, fatty fish, cranberry and pomegranate juices, and plant protein powders- there are three that I especially have found of value :
- Mycopure by Designs For Health– from the company: MycoPure™ is a plant-based protein powder (from pea and rice) fermented from shiitake mushrooms. It also features Immune-Assist™, a blend of medicinal mushrooms that offers robust immune support.** Shiitake fermented protein contains all 9 essential amino acids, has a high branched-chain amino acid (BCAA) composition, and has a PDCAA (Protein Digestibility Corrected Amino Acid Score) of 1.00.
- Functional Plant Protein + Prebiotics by Klaire Labs– from the company: Functional Plant Protein Dark Chocolate & Sea Salt combines USA-grown, sustainable pea protein with microbiome-nourishing prebiotics and antioxidants. This great-tasting, bioavailable, and easy-to-digest protein formulation is 100% dairy-free and non GMO.†
- LifeCORE complete by Ortho Molecular Products– from the company: LifeCORE™ Complete is a balanced nutritional shake, free from common allergens, such as gluten, soy, and dairy, and does not contain fructose or any genetically-modified foods. It provides a diverse blend of pure plant proteins combined with other essential nutrients and fiber to create a complete source of balanced daily nutrition. It also has carnitine, taurine, ground flaxseed powder, and olive oil powder.
To order any of these supplements from Dr. Pappas’ practitioner dispensary account, please click HERE!
Antimicrobial Effects of Pomegranate Juice
Anti-Viral Properties of Cranberry Juice
- Antiviral effects of cranberry juice and cranberry proanthocyanidins on foodborne viral surrogates – A time dependence study in vitro
- Cranberries Connected to Antiviral Effects
Cranberries might display antiviral properties according to independent research published earlier this year in Phytomedicine. The researchers found that cranberry juice offers a nonspecific antiviral effect toward viruses, including rotavirus.
The researchers, from various academic institutions in New York, found that cranberry juice drinks reduced the infectivity of the viruses by up to 92%. Other juices, such as orange and grapefruit juices, reduced the infectivity of the viruses from 25% to 35%.
Intermittent Fasting and the Immune System
With fewer nutrients available in the bloodstream Belkaid says, these immune cells migrated to food-rich bone marrow compartments where they can survive during a fast. In Belkaid’s study, she found that memory T cells, which produce molecular weapons to kill pathogens and cancers, suddenly became supercharged when they retreated to the bone marrow. “Not only were they able to survive, they were also optimized, and these T cells were able to protect [the body] better,” Belkaid says.
When the mice in her study were injected with a pathogen that they’d already fought off once before, well-fed mice took around a week to destroy the pathogen. Mice that were fasting cleared the infection in two days.
From The American Nutrition Association:
- “All personalized nutrition health professionals are critical members of the healthcare workforce. And it is crucial that every person is provided guidance to boost overall health, to help ward off infection and to reduce the burden on our healthcare system.”
- “Nutrition healthcare professionals are on the front lines, keeping people healthy. It is vital that every person optimize their health, to help ward off infection, and to reduce the burden on our healthcare system.”
Sauna and the Immune System:
A new study found that using the sauna was associated with a decrease in a biomarker of inflammation (CRP) in a dose-dependent manner. The more frequent the sauna use, the more robust the effect of lowering inflammation. This study was published early this year with one of the world’s leading sauna researchers, Dr. Jari Laukkanen.
As Rhonda Patrick, Ph.D. of the first article has stated about saunas- although it is not a treatment, its use:
- Increases immune cells
- Associated with reduced incidence of respiratory diseases
- Increases Heat Shock Proteins which activate the innate immune response (in addition to his cardioprotective and neurodegenerative benefits)
Sunlight and the Immune System
I know this will trouble my dermatology friends and those of very pale complexion, but the reality is that safe and controlled exposure to the sun is beneficial for most people and has been the source of much health abundance for millennia. Just don’t get sunburn and protect your face. From Georgetown University:
Sunlight allows us to make vitamin D, credited with healthier living, but a surprise research finding could reveal another powerful benefit of getting some sun.
Georgetown University Medical Center researchers have found that sunlight, through a mechanism separate from vitamin D production, energizes T cells that play a central role in human immunity. Their findings, published today in Scientific Reports, suggest how the skin, the body’s largest organ, stays alert to the many microbes that can nest there.
“We all know sunlight provides vitamin D, which is suggested to have an impact on immunity, among other things. But what we found is a completely separate role of sunlight on immunity,” says the study’s senior investigator, Gerard Ahern, Ph.D., associate professor in Georgetown’s Department of Pharmacology and Physiology. “Some of the roles attributed to vitamin D on immunity may be due to this new mechanism.”
Ways to Optimize Lung Health:
The Innate and Adaptive Immune Systems:
Basic information on the two different types of immune systems. Important to understand these basics as we teach ourselves how to improve our immune system and learn about the effects on our body of this novel virus.
SARS-COV2 and Viral Replication in Our Cells
- COVID-19 (SARS-CoV-2) Assay Tests
- Can old drugs take down a new coronavirus?
COVID-19/SARS-CoV-2 Pandemic | FPM
Natural Support -Nutraceuticals, Vitamins, and Supplements
This disclaimer from my first write-up remains important to keep in mind:
“It is unlikely that herbal extracts and nutraceuticals hold drug-like “cures” for coronavirus and leading nutraceutical and supplement manufacturers have stressed this point. Furthermore, per Erik Goldman, “While research supports the use of certain dietary supplements to maintain immune system health, we are not aware of clinical research that demonstrates using a dietary supplement specifically to prevent or to treat the novel coronavirus. Even if research is conducted and published on the topic, the law that regulates dietary supplements… prohibits marketers in the United States from promoting any dietary supplement product that makes disease prevention or treatment claims.”
Science-based podcast presented by physicians whose work I admire. Their Google Drive document of actual research is worth the price of admission (which, fortunately, is free).
- Drs. Todd Lepine and David Brady on a podcast through Designs For Health: Current Controversies in Natural Therapeutics of Immune Support_March 2020.mp4
- Research referenced in google drive: Current Controversies in Natural Therapeutics of Immune Support Webinar Literature
Jeff Bland, Ph.D. the legendary scientist and one of the founders of Functional Medicine reflects on COVID.
There is now evidence that certain lifestyle and environmental factors can serve as immunoadjuvants. Once identified, these factors can lend themselves to specific personalized intervention that is focused on the renewal of immune system function, as well as increased resilience. I break down the social and biological categories mentioned in the preceding paragraph in the following way. Potentially modifiable social factors include things related to structure and behavior, such as housing, transportation, communication, health care systems, politics, and economics. What about biology? Here I would place potentially modifiable factors like stress, environmental toxicity, diet and nutrition, physical activity, sleep, hydration, intestinal microbiome composition, and biological rhythms. It is generally recognized that social factors are challenging to modify, whereas biological factors are personal and therefore an individual has a greater locus of control.
From past pandemics, we know that different viral infections influence differing percentages of people within a population, but that the majority is generally not infected. There are many reasons for this that are not fully understood. The biological factors I have outlined–environmental exposures, diet, stress, medications, and sleep — are becoming more well established as key factors that influence immune system integrity and defense against viral infection. It is now recognized that more than 20 million Americans are routinely taking various drugs that suppress the immune system and can change the way the body responds to viral and bacterial infections. This means that other lifestyle and dietary factors that influence the integrity of the immune system have become even more important in the age of globally transmitted viral diseases.
An overview of nutritional findings looks like this: a study of people who followed an unprocessed diet plan rich in plant foods and also engaged in regular daily activity plus time spent outdoors in cooler temperatures, revealed that their immune system function and resistance to infection was improved.[8] It has also been reported that the Mediterranean Diet improves immune function and lowers the incidence of recurring viral respiratory infections.[9] Vitamin and mineral content of the diet may play an important role in reducing the risk to hepatitis C viral infection.[10] Plant foods that contain phytochemicals such as flavonoids have been found to improve immune resistance to viral infection.[11] Finally, probiotics that help support a healthy intestinal microbiome have been reported to enhance the antiviral effects of vaccination in elderly patients, which demonstrates the important role the microbiome has in immune function.[12]
A deeper look at individual nutrients is revealing. Numerous studies spanning 30 years have demonstrated the anti-viral influence of vitamin C and its importance in reducing the risk and severity of infections.[13],[14] Significantly, the resistance to viral infections that are linked to vitamin C has been demonstrated in children as well as adults.[15] Vitamin C use that exceeds dietary intake has also been shown to be valuable in improving immune response to viral infection.[16]
Active application of the principles that underlie personalized lifestyle health care, as described in an article I authored with my colleague Deanna Minich, Ph.D., in 2013, and a focus on the modifiable biological factors associated with immune defense to viral infection creates a significant opportunity to reduce both morbidity and mortality associated with viral crises.[24]This was a lesson we learned in the 1980s with HIV/AIDS, and this is an important lesson to relearn as the battle to contain and mitigate COVID-19 approaches new levels of global uncertainty and concern.
Dr. Leo Galland, a pioneer in the field of lifestyle and functional medicine, writes about the Coronavirus and a sound protection protocol based on science.
If you are exposed, there are measures you can take, based on the biology of the virus, which may diminish the likelihood of severe illness. These are not treatments for disease; they are preventive strategies to help place you among the 80% with mild to minimal illness and they have the greatest chance of succeeding if they are implemented before you are exposed.
ACE-2 Enhancement
Regular aerobic exercise and a plant-based whole foods diet are associated with improved ACE-2 function. Natural substances shown to enhance ACE-2 function include curcumin (a set of flavonoids found in the spice turmeric), resveratrol (a polyphenol found in red grapes and other foods), rosmarinic acid (a polyphenol found in spices like rosemary and oregano), Panax notoginseng (an herb used in some traditional Chinese medicines—the active Panax fractions for strengthening ACE-2 are called saponins), and alpha-lipoic acid (an anti-oxidant). Resveratrol has a number of beneficial effects on coronavirus beyond ACE-2 support; it inhibits the growth of the deadly MERS coronavirus by multiple mechanisms. In addition, resveratrol and rosmarinic acid each diminishes the kind of inflammation associated with corona virus infection.
3CL protease inhibition
Elderberry fruit (Sambucus nigra) inhibits the viral enzyme 3-CL protease and has been shown to inhibit coronavirus activity in cells. Elderberry seems to be most effective if started before infection and continued through the initial period of infection. It may be contra-indicated in Phase Two of COVID-19, because of its immune-boosting effects. Elderberries’ 3CL protease inhibition is related to its content of flavonoids, especially those called anthocyanins, and its immune-stimulating activity is related to its complex sugars (polysaccharides). When taking elderberry, make sure its flavonoid or anthocyanin content has been standardized. Elderberry extracts are safer than raw elderberry fruit. Concerns have been raised about the immune-stimulating effects of elderberries. These are addressed in the next section because they apply to all immune-enhancing therapies. There are several other dietary flavonoids that inhibit coronavirus 3CL protease. The most potent according to one detailed study was herbacetin, which is primarily found in ground flaxseed (not in flaxseed oil but in the husk).
Enhancement of Innate Immunity
The innate immune system is present at birth and is ready to attack microbes on contact. Its function is supported by adequate sleep and moderate exercise. The most important dietary component for its maintenance is protein. Protein deficiency impairs innate immunity, but there is no evidence that excess dietary protein improves it beyond the effects of a normal healthy diet. Your protein intake in grams should be about half your lean body weight in pounds.
Vitamin D, vitamin A, and zinc are essential for innate immunity but excess levels of these actually impair immune function. Almost everyone should supplement with Vitamin D through the winter, but the dose needs to be individualized over a range of 1000 to 5000 IU/day. Vitamin D is best absorbed with a large meal. Vitamin A (in the form of retinol) and zinc should only be supplemented if blood levels are low. Many integrative physicians make the mistake of measuring zinc in red blood cells or whole blood; this is not an accurate reflection of zinc status. Plasma zinc or white blood cell zinc is much more meaningful. Inflammation leads to sequestration of zinc in the liver so that less zinc is available to cells. Quercetin binds to zinc and helps to increase the amount of free zinc in cells, so there may be a role for quercetin and zinc taken early in the course of infection.
Melatonin is a hormone made by the pineal gland at the base of the brain. It supports anti-viral immunity and also helps to control the inflammation produced by coronavirus infection. Your body makes melatonin in the dark, mostly between 2-3 AM. Children make much more melatonin than adults, which is one reason why they may be more resistant to illness from COVID-19. Don’t watch late-night television or use a video screen after midnight. Limit artificial lighting at night. Cherry juice contains low levels of melatonin (about 40 micrograms in 8 ounces). Drinking cherry juice (about 16 ounces a day) can significantly increase blood levels of melatonin. You can also take low dose melatonin as a supplement, about one-half milligram (0.5 mg) around 10 PM. If you get sick, you may need more. Melatonin specifically inhibits an inflammatory cascade that produces cell damage during coronavirus infection, the same target that is blocked by resveratrol and rosmarinic acid (it’s called the NLPR3 inflammasome). The anti-inflammatory effect of melatonin may be enhanced by high doses of vitamin C.
Medicinal and dietary mushrooms contain polysaccharides that can stimulate innate anti-viral immunity. The most studied are turkey tail (Coriolus or Trametes Versicolor), maitake (Grifola frondosa), shiitake (Lentinula edodes), and reishi (Ganoderma lucidum).
Probiotics and prebiotics may impact innate immunity by creating a gut microbiome that stimulates the immune system. Research in this area is in its infancy. Prebiotics with the best evidence for immune stimulation include beta-glucans, arabinogalactans, and galacto-oligosaccharides. These are readily available as powders. Probiotics with the best evidence for immune stimulation are Lactobacillus species, especially Lactobacillus Plantarum, which is found in sauerkraut and other fermented plant foods, and spore-forming bacteria of the genus Bacillus, which are normally found in soil. Several preparations are commercially available. Because COVID-19 has many mechanisms for evading innate immunity, even when it is strong, immune enhancement by itself is not a promising approach for preventing severe infection.
IFM-Institute of Functional Medicine recommendations on lifestyle and nutraceuticals
- Boosting Immunity: Functional Medicine Tips on Prevention & Optimizing Immune Function During the COVID-19 (Coronavirus) Outbreak
- The Functional Medicine Approach to COVID-19: Virus-Specific Nutraceutical and Botanical Agents
COVID-19: Nutraceutical and Botanical Recommendations for Patients
Dr. Weil and a group of colleagues add their perspective
Drs. Andrew Heyman and Richie Shoemaker-From Surviving Mold and CIRS renown
Will we be afflicted like the American Indians, Aztecs, and Incas dealing with new European illnesses like smallpox, measles, tuberculosis, and pertussis (among many others) because these illnesses were new to the inhabitants of the Americas 500 years ago? Susceptibility to life-threatening illness is multifactorial and is not just due to immune and antibody deficiencies. Will we see those living in crowded conditions suffer more from overactive immune responses like we saw in the 1900s with rheumatic fever? And if COVID-19 sickened patients solely due to lack of protective antibodies, what basis is there for the repeated observation of age stratification of death?
My friend and fabulous researcher, Josie Nelson, sent me the next two links: the research behind vitamin C and the previously referenced article by Dr. Marik. Here he shares his data on the supplements that protect against COVID.
Orthomolecular Medicine News Service, Mar 22, 2020
Vitamin C supports your immune system. Vitamin C helps to kill viruses and reduces the symptoms of infection. It’s not a COVID-19 “cure,” but nothing is. It might just save your life, though, and will definitely reduce the severity of the infection. If someone tells you it’s not proven, consider two things:
- Nothing is proven to work against COVID-19 because it is a new virus
- Vitamin C has worked against every single virus including influenzas, pneumonia, and even poliomyelitis.
In the medical literature, there are more than 64,000 published articles and studies on Vitamin C available at The U.S. National Library of Medicine National Center for Biotechnology Information. Vitamin C is arguably one of the most researched substances in existence. Much of the research is very positive. Ignorance of the research, benefits, and use of Vitamin C is not a valid excuse for it not to be used as a therapy, particularly when there are no other known medications available, and it is not likely to cause damage, and the published research is readily accessible for everybody.
-The authors proceed to list numerous articles about Vitamin C which can be found in the link above. Of note, there are reports that doctors in China used Vitamin C along with more traditional treatments for COVID and that American doctors are also using IV Vitamin C in ill patients.
Dr. Marik- ICU doctor -COVID protocol for home
Zinc (Zn++) inhibits viral RNA dependent RNA polymerase (replicase). Chloroquine and hydroxychloroquine are potent Zn ionophores that increase intracellular Zn concentrations.
Ascorbic acid has numerous proven biological properties (anti-inflammatory, anti-oxidant, immune-enhancing, antiviral) that are likely to be of benefit in patients with COVID-19 disease. Furthermore, it is important to stress that ascorbic acid has proven synergistic effects when combined with corticosteroids. Therefore, steroids are recommended in patients with COVID-19 and respiratory failure. The benefit of ascorbic acid (without corticosteroids) in patients with severe respiratory failure appears to be limited. While the optimal dose of ascorbic acid is unknown, we suggest 3 g IV q 6 hourly. It should be noted that in the presence of free iron (released from ferritin) ascorbic acid may potentially have pro-oxidant effects. Therefore, the trends in CRP and ferritin need to be closely monitored; in those patients who ferritin AND CRP are increasing, reducing the dose to 1.5g q 6 hourly should be considered.
Very recent data suggest that in addition to being a potent antioxidant, melatonin may have direct antiviral effects against COVID-19. In healthy people, melatonin levels plummet after the age of 40 years. This may partly explain the increased risk of death in patients with COVID-19 who are over the age of 40. Melatonin may, therefore, have a role in both the prevention and treatment of COVID-19.
Vitamin D has important immune-enhancing effects. Much of the population, especially the elderly have suboptimal vitamin D levels, particularly during the winter months. Low vitamin D levels have been shown to increase the risk of developing viral upper respiratory tract infections. Therefore, prophylactic vitamin D should be considered especially in the elderly.
Quercetin is a plant phytochemical. Experimental and early clinical data suggest that this compound has broad antiviral properties (including against coronavirus) and acting at various steps in the viral life cycle. This readily available and cheap plant-derived compound may play a role in the prophylaxis of COVID-19 in high-risk populations.
Zinc
Many studies on the antiviral effects of zinc. It has also been used in conjunction with medical treatments for COVID. Zinc deficiency is also common and important to keep in mind.
- Zinc could help diminish the extent of COVID-19
- Role of Zinc in Antiviral Immunity | Advances in Nutrition | Oxford
- Inhibition of H1N1 influenza virus infection by zinc oxide nanoparticles: another emerging application of nanomedicine
From my friend and superb nutritionist Kelly Dorfman, who’s been practicing in the care of children and adults for over 30 years in the DMV and has become one of the world’s foremost experts on using nutrition therapeutically to improve brain function, energy, and mood. Her excellent COVID articles include a superb discussion of zinc.
SPM- Specialized Pro-Resolving Mediators enriched fish oils- helps the immune system
“Promoting the resolution of inflammation allows the body to defend better.” SPMs are one of my new favorite supplements. I began then as a tool for help in controlling inflammation and have only recently discovered their immune system benefits as outlined below. The 2nd article references a trial using the SPM by Metagenics that I personally use since they also help raise omega 3 fats- I find them doubly helpful.
- Special pro-resolving mediator (SPM) actions in regulating gastrointestinal inflammation and gut mucosal immune responses
- SPM-enriched fish oils may help control immune responses
- Key roles for lipid mediators in the adaptive immune response
Anise in plants and liqueurs may have immune and anti-inflammatory properties. Time to have more Greek Ouzo, Lebanese Arak, and French Pastis?
Medicinal herbs are one of the imperative sources of drugs all over the world. Star anise, an evergreen, medium‐sized tree with star‐shaped fruit, is an important herb. Besides its use as a spice in culinary, star anise is one of the vital ingredients of the Chinese medicinal herbs and is widely known for its antiviral effects. It is also the source of the precursor molecule, shikimic acid, which is used in the manufacture of oseltamivir (Tamiflu®), antiviral medication for influenza A and influenza B.
- Low Incidence of Rheumatoid Arthritis in France: Scandinavian Journal of Rheumatology: Vol 23, No 5
- Prevalence and management of rheumatoid arthritis in the general population of Greece—the ESORDIG study
Learning and Educational Resources
I close this section with what I’m reading or studying since I’ve been asked this often, mostly outside of my medical and COVID-19 topics. The following is with the caveat that I describe myself as an ADD reader, reading many books at the same time. To paraphrase the late Senator Daniel Patrick Moynihan, I read in many books but don’t necessarily finish them.
I’m re-reading parts of the first three books listed below.
Not only do I personally know the first two authors, but I also have found their writings and talks in general and these books in particular of great value during uncertain times. Whether it’s learning about how the greatest leader of the 20th Century faced his most pressing challenges from the most eminent Churchillian scholar or about the resiliency of Greek villagers and how they channel their inner Hellenic wisdom and psychological fortitude from a legendary Modern-Day Greek Philosopher and doctor of meaning, there is much for we moderns to learn.
- Churchill’s Trial: Winston Churchill and the Salvation of Free Government by Larry P. Arnn
- The OPA! Way: Finding Joy & Meaning in Everyday Life & Work by Alex Pattakos, Elaine Dundon
The following book from the great military historian, renowned classicist, and expert in geopolitics, Professor Victor Davis Hanson, is one of his many looking at what history can teach us about modern problems. He looks at three legendary, if also often forgotten generals and how they led morally sound armies in liberation over tyrannical enemies. Important modern lessons I believe include the wise interpretation of Professor Hanson to never take counsel of your fears and pursue the enemy with the utmost audacity. For extra credit, I would recommend reading it to also learn about one of the most underappreciated great Ancient Greek leaders and general, Epaminondas. For he was not only Plutarch’s 1st Great Man of Greece in his Parallel Lives, but also a unique commander of men who lived a life of monastic simplicity, impressive military authority, and genuine leadership. The fact that both he and Plutarch are from my family’s region in Greece is only icing on the cake.
- The Soul of Battle: From Ancient Times to the Present Day, How Three Great Liberators Vanquished Tyranny by Victor Davis Hanson
Others in my current revolving circle:
- Incerto 4-Book Bundle: Fooled by Randomness, The Black Swan, The Bed of Procrustes, Antifragile by Nassim Nicholas Taleb
- The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry
- Churchill and de Gaulle: The Geopolitics of Liberty by Will Morrisey
- Grand Strategies: Literature, Statecraft, and World Order by Charles Hill
- The Roots of Christian Mysticism: Texts from the Patristic Era with Commentary by Olivier Clément
- Paideia: The Ideals of Greek Culture: Volume III: The Conflict of Cultural Ideals in the Age of Plato (Paideia, the Ideals of Greek Culture) by Werner Jaeger (Author), Gilbert Highet (Translator)
The next book was the basis of a project my brother and I had begun B.C.- Before COVID. We had been collaborating on content and ideas to help our tribe optimize their Leadership Health through the emulation of the timeless principles found in the first hackers and men of action both on and off the battlefield of life- the Ancient Greek Olympians and Athletes. Their mind-body training which had its roots in the Ancient Greek Gymnasiums created a resilient foundation for the unprecedented nature of their tenuous life and which is needed now more than ever in our modern turbulent times.
- Ancient Greek Athletics by Stephen G. Miller
And lastly, for the pure joy of heroic storytelling that all men young and old who love action, engaging fiction, and a good story should read. I was introduced to it by my brother and has been loved by my sons as well. A fabulous retelling of the Trojan War that I re-read every few years. His other books are great heroic fiction as well with a little sci-fi and plenty of action. Two of the best storytellers, including the renowned Steven Pressfield, have glowing praise for the late great British storyteller.
- Troy: Lord of the Silver Bow (The Troy Trilogy Book 1) by David Gemmell
“This is how the oldest tales should be read and known. This is the grand style of storytelling. Gemmell is a master of plot, but his triumph is creating men and women so real that their trials are agony and their triumph is glorious.”
–Conn Iggulden, author of the Emperor series
“I can say of David Gemmell, that he’s the only writer of historical fiction or heroic fantasy whose prose I actually study, line by line, trying to decode how he produces the effects that he does. Hail to Lord of the Silver Bow! Bravo, Mr. Gemmell!”
–Steven Pressfield, author of Gates of Fire and The Virtues of War
From my brother Tom:
The Coronavirus epidemic has unexpectedly forced most of us to adjust our daily schedules.
For most of us white-collar workers, we’ll see a drastic improvement in our ”commute” times.
What will you do with these extra 1 to 2 hours of time on your hands? In addition to the good health practices the good doctor my brother advocates, don’t forget to work your mind. There’s no better way to do this than start a reading practice. Here is an article from our blog to get you started: How to Start a Reading Practice: Heavy Lifting for your mental leadership muscles
And here is a classic book The Expedition of Cyrus, by Robin Waterfield (Author), Tim Rood (Editor, Introduction, Translator), to add to your reading journey. In addition to being a great adventure story, it is the first (and arguably the best) account of crisis management in history. As we deal with the post-COVID-19 world, Xenophon has a lot to tell us as leaders dealing with unprecedented, challenging conditions.
On my future to-do list, based on the recommendation from one of our most learned and well-read patients: Leading at The Edge: Leadership Lessons from the Extraordinary Saga of Shackleton’s Antarctic Expedition Paperback by Dennis Perkins (Author), Margaret Holtman (Contributor), Jillian Murphy (Contributor).
I’m about to begin a Hillsdale College online course on American History with my sons from the acclaimed new book by Professor Wilfred McClay’s A Land of Hope. I have found Hillsdale’s prior online courses to be excellent. Hillsdale College Online Courses
The Cana Academy I mentioned in the 1st section of this report remains a valuable Classical education resource that I look to regularly. I can personally attest to the quality of the work and teaching method of the organization and its leadership team.
Into the Unknown
Chris Kresser, an integrative health leader states powerfully:
“The world is changing, and we need to adapt and change with it.”
What will these changes look like? While we don’t know for sure yet, we can make some predictions:
- Remote by default (vs. office by default)
- Digital (vs. physical)
- Eating at home (vs. eating out)
- Home & family (vs. commuting and traffic jams)
- Local economy (vs. globalization)
- Functional Medicine (vs. conventional medicine)
- Health and nutrition coaching (vs. taking pills)
- Telehealth (vs. in-person visits)
- Wellness as a necessity (vs. wellness as a luxury)
We think of this excellent list as we focus on supporting our patients during these unknown times. As I responded to a good friend who inquired about our non-hospital role in taking care of COVID-19 disease, “We are at the tip of the spear and have seen the eyes of the enemy.” Our unique role of being knowledgeable and passionate at the crossroads of not only health and disease but also the high tech of laboratory data and immune system evaluation coupled with the high touch of personalized medicine and lifestyle coaching has allowed us to provide many tools for our tribe. We continue to use all available instruments to help our circle of excellence and like Alexander the Great go around any obstacle with the A team of Tamara and Collin leading the charge. We are grateful for all of your support and faith in us.
As we think of our health care colleagues manning the front lines in the hospitals and the equally important task of our peers trying to prevent and treat low-level COVID symptoms we are appreciative of the unique role our field has and feel much admiration for the heartfelt work they are all doing.
However, we know the healthcare industry is at a tipping point and in need of new thinking and thus are cautiously hopeful ideas we have been championing can get a foothold in a very stubborn field. We implore our colleagues to expand their horizons and take deeper dives in essential areas they are not comfortable with. Most internists and family doctors need to give more value through lifestyle medicine and advanced laboratory testing to better partner with patients. This goes equally for the majority of those in “concierge” medicine who, although do spend more time in communication and coordination with their patients, continue to have their ladder on the wrong wall as they shun advanced studies and technology for paltry lab assessments and disdain or at least an indifference for lifestyle medicine including diet, exercise, and the unique role of the citizen scientist.
TESTIMONIAL
From a long-time patient, we are grateful for his recent supportive words.
Dear Sam, Tamara, Collin,
I hope this text finds each of you and your families doing well and safe. I wanted to take a second to say “Thank You” so much for being part of the most vital group of health care professionals taking care of our country during this moment in time.
A lot of attention recently has been understandably and appropriately focused on “first responders” and health care workers in the hospital trenches. Less so has gratitude been extended to the countless private practitioners out there providing advice, counseling, and “comfort” to their individual private patients who are sheltered at home.
Pappas Health needs special mention, however, especially because you deliver personalized and direct and very accessible healthcare services that are not caught up in a big bureaucratic HMO or hospital corporation. I know that you guys are closely researching and monitoring the various treatment and medical news, trials, and other aspects of this COVID situation and having you there to ask questions and to be there when your patients need you (as you always are) is of indescribable comfort and well-being. The patients of Pappas Health, and I among them, are incredibly lucky. Thank You 
Tom T –corporate athlete, leader, and Pappas Health member
I close with my new pinned Twitter heading. I try to capture in picture and words the foundational depth and varied tools necessary for a physician to combat disease and help restore health. I use both sacred and profane symbols, from the sanctified canopy of inspirational texts of faith by a famous physician-philosopher to the ancient physician using his might and legendary Rod of Asclepius, which so influenced Hippocrates and who swore to Hygieia and Panacea- much needed in our time of pandemics and pestilence.
The entire excerpt, in appreciation to Maimonides’ role as a healer:
The physician fulfills the basic biblical obligation to return lost objects to their owner, for with his knowledge and experience the physician can restore good health to his sick fellow human being.
Medicine provides a unique opportunity to practice imitatio dei, as it reflects the religious duty to maintain a healthy lifestyle.
As an important natural science, medicine offers tools to recognize, love, and fear God.
These three aspects address man’s relationship and obligation towards his fellow man, himself, and God. -Maimonides Appreciation for Medicine, Benjamin Gesundheit MD, PhD
