A COVID-19 Survival Guide (w/Dr. Ron Sinha)

Dr. Z: Hey, ZPac what’s up. It’s Dr. Z. Okay. Today I have back returning the show, my good friend, Dr. Ronesh Sinha. He is an internal medicine physician and a master of wellness of all kinds including corporate wellness at m y old alma mater, the Palo Alto Medical Foundation here in the Bay Area. Ron, welcome back to the show, man.

 

Dr. Sinha: Great to be here again. Thanks for the invite.

 

Dr. Z: Dude, so we always talk about stuff that like gets me excited like metabolic disease and South Asian people in their general health. But you, during the whole pandemic, you’ve become kind of this guru of how we can actually, we all talk about how do we not get COVID, how do we cure COVID, how do we treat COVID, but we’re not talking about, well, what happens to you that can lower your risk of getting really sick from COVID. And that’s something you’ve been talking about a lot. So, that’s why I wanted to have you back so we can really dig into that and to be a nice social distance away instead of on Zoom, which is just no fun.

 

Dr. Sinha: Right.

 

Dr. Z: How tired of you of Zoom by the way.

 

Dr. Sinha: Very tired. That’s why I’m here. This is like a vacation for me. So, thank you for inviting me to your studio.

 

Dr. Z: Yeah, me too. It’s like it’s really the only reason I still do the show. I’m like whatever, medicine whatever, but man, I get to see people. That’s great.

 

Dr. Sinha: Right.

 

Dr. Z: So, tell me how you like to think about this and talk to your patients about this who many of whom were at risk.

 

Dr. Sinha: Yeah, and you know, I never thought that after our last show, I’ll be back here talking about COVID and lifestyle again. I was hoping it’d be a passing ship, but what I can tell you is since that show till now and after seeing patients, it’s been gratifying because a lot of people that have followed these lifestyle principles and really focused on their own immune system, their own metabolism, they’ve told me that they have sailed through COVID. Many of them have just gotten the infection and they’re like, “It was nothing more than just a cold.” And this is anecdotal. Again, I don’t have a randomized control study to show you that this is truly the fact, but it is incredible to see that people that have prioritized their health, their wellness, their metabolism, their diet, they’re really doing super well. So, I wanna basically bring some of that feedback in terms of what are the key elements I think that helped people get through COVID-19 in a really eventless sort of way.

 

Dr. Z: Yeah, and this is key because so many people have very mild courses. And we’re not talking about long haulers and all of that. That may be a different show. But we’re talking about people who really like you said, they sail through it.

 

Dr. Sinha: Right.

 

Dr. Z: And if we can optimize people’s chances of being that person, some of it’s genetic, right though. It’s not all lifestyle.

 

Dr. Sinha: Yeah, exactly. You’re right there. There’s a genetic component. But like with most chronic health conditions, the lifestyle trumps the genetics by so much. So, that’s what we’ll focus on today.

 

Dr. Z: Yeah, and that’s important to double down on the lifestyle trumps genetics. So, the genetics, aren’t a doomed statement here. It’s not like a predestined thing. You can actually outwit your own genetics by changing lifestyle.

 

Dr. Sinha: Exactly. Right.

 

Dr. Z: Yeah. So let’s talk about it. So, what do you, how are you thinking about this? Teach me how to be safe.

 

Dr. Sinha: So, my new way of reframing COVID-19, we know it’s an infectious disease, but if you really wanna think about how you can literally sail through it, you gotta think of it as a metabolic disease. Because really when COVID-19 infects our body, what a lot of people don’t realize is it actually changes the way our cells perform metabolism. So, as I was thinking about metabolism can be complicated word. And Z, I was thinking about how do I make this colorful for your audience who loves music and creativity? So, I thought back to the summer where there was a song that kept getting played on the radio they got really tired of, and it was “Watermelon Sugar” by this Harry Styles guy. So I’d hear it all the time. And then one of my friends sent me the video. I watch a video I’m like, “Okay, this is really annoying, but I’ve gotta reframe this in some way where I can take this song that destroys my soul and I can turn it into a teaching point.”

 

Dr. Z: Watermelon Sugar. Oh man. Now it’s gonna be stuck in everyone’s head.

 

Dr. Sinha: Okay. So, exactly. And that’s the way we’re gonna make this stick.

 

Dr. Z: Brilliant.

 

Dr. Sinha:  So, last night I went to the grocery store and I brought a watermelon.

 

Dr. Z: Did you wear a mask?

 

Dr. Sinha:  Of course I did. Yes, all the way.

 

Dr. Z: Uh-huh. Okay. Good.

 

Dr. Sinha: N95 baby.

 

Dr. Sinha: Yeah, here we go. So, here we go. This is watermelon right here.

 

Dr. Z: Raise it up a little bit. Yeah, there it is.

 

Dr. Sinha: Okay. Yeah, do you see it?

 

Dr. Z:  Yeah.

 

Dr. Sinha: So, this is a cross section of a cell. And last time we talked about it being a lung cell but I’m gonna make this an immune cell, a macrophage to be specific. Because our immune cells is just like our muscle cells, actually have their own metabolism. So, if this is a cross section of a cell, this orange persimmon that I put here, this is your mitochondria. Okay?

 

Dr. Z:  Nice.

 

Dr. Sinha: So, we’re gonna pause there for a second. So, basically this area, the red area is what we call the cytoplasm or the cytosol. And this is basically your mitochondria. Now, it’d be very easy for us to think about glucose here. This is a watermelon sugar. And when we think about metabolism, basically what we want to do when we exercise, when we want our immune cells to optimize your performance, is we want them to tap into the mitochondria to produce energy so the cell works and fires at the right level. But what we’re seeing in COVID-19 is when you start getting short of breath, your body produces chemicals, and one of them is called HIF, hypoxia-inducible factor. What that literally does is it actually shuts off the mitochondrial metabolism. So you can’t generate as much ATP. As a result of that, Z, what’s happening is in this part of the cell, our body is using glucose in creating a lot of what we call aerobic glycolysis and anaerobic metabolism. And those are fancy words for saying that we’re in a hypermetabolic state. So, literally our immune cell is doing a bootcamp class or doing a HIIT training session. And as a result of doing metabolism in this portion outside of the mitochondria, you’re getting massive loads of cytokine, you’re getting lactate production from that anaerobic metabolism. So, this becomes a very high energy cell. And this is very similar to what happens in a lot of cancers. We call this the Warburg hypothesis where basically we’re shifting metabolism here but we’re not tapping into the power of the mitochondria. So, I’m gonna pause there for a second in case we need to clarify something.

 

Dr. Z: So, excellent. So, when you learn in high school, the mitochondria is the powerhouse of the cell.

 

Dr. Sinha: That’s right. Yeah.

 

Dr. Z: So, what we’re saying here is you’re saying there’s, a shift metabolically from an aerobic sort of metabolism that generates a ton of ATP efficiently in the mitochondria, to a more cytosol-based anaerobic metabolism that this particular infection may trigger and that explains to some extent, some of the lactate production, the cytokine production, and the general disorder. And you brought up this Warburg effect or…

 

Dr. Sinha: Exactly. Yeah.

 

Dr. Z: Which is a theory around cancers, that these cancers actually tend to anaerobically metabolize. They lose the ability to respire oxygen properly. And that’s one of the dysfunctions. And so, you’re actually potentially linking metabolically these kinds of concepts with COVID-19.

 

Dr. Sinha: Exactly right.

 

Dr. Z: Got it.

 

Dr. Sinha: And then I wanna come back to that one switch molecule, the HIF, the hypoxia-inducible factor because-

 

Dr. Z: Yeah, I’ve never heard of that. Yeah.

 

Dr. Sinha: Yeah, so the interesting thing about HIF, is this is something our body produces when we exercise. So, when we exercise really intensively, our body produces HIF. It shuts off the mitochondria and that’s where we go in into anaerobic metabolism our muscles burn, we’re breathing heavy, our heart rate goes up. So, our immune cells do the exact same thing. So, the key here is we don’t want HIF to turn on too quickly because that’s what’s gonna rev up our metabolism and cause that hyper inflammatory response. So, let’s fast forward to somebody who’s been sedentary for the last several months. Hasn’t gotten any exercise. With even minimal physical activity, their body is gonna switch on that HIF and shut off this aerobic metabolism in the mitochondria. So, that’s why I’m kinda linking metabolism at the cellular level to what’s happening to people when they become short of breath at the macro level from being inactive.

 

Dr. Z:  So, this is kind of like a couch potato syndrome. So, if you’re deconditioned aerobically, your tendency to turn on this HIF and go into anaerobic metabolism has a lower threshold. So, you’re more likely to do that quickly.

 

Dr. Sinha:  That’s exactly right.

 

Dr. Z: Right.

 

Dr. Sinha: Yep.

 

Dr. Z: And so, the question then becomes, if COVID takes advantage of that pathway to cause havoc and you’re more resistant to activating that pathway through aerobic conditioning, being in better shape for lack of a better term, you might have a better chance of riding out the disease.

 

Dr. Sinha: That’s exactly right. And remember we talked about before that the lungs are really the primary target. So, when you have more aerobic resilience and more aerobic fitness, that sensation of air hunger, that threshold basically it goes up so significantly there. You’re not gonna feel that sensation of hypoxia. You might recall we talked about sort of mask-wearing fitness, where you wear a mask and you go out. People that are not very fit, you ask them to walk a quarter of a mile and they feel suffocated. But many of my patients who I have encouraged to just go out and exercise with your mask on. They found that it does not cause as much hypoxia after just a couple of weeks. So, their ability to actually exercise in a low-oxygen environment, aka wearing a mask is actually significantly heightened. They’re able to do that much better. So, my theory based on this is if they were to get an infection like COVID, it were to affect their lungs, because it built up that aerobic foundation, they’re not gonna switch on all these inflammatory signals and molecules that can shift them into this hyper inflammatory metabolic state that we talked about.

 

Dr. Z: Hmm. Do you think there’s any, and that brings up the question that I don’t know if anyone’s looked at this, but like higher altitude people who are adapted to higher altitudes like Colorado, et cetera are they more resistant to-

 

Dr. Sinha: So, I love that question. I’ve been looking for that data. I haven’t found it. But you’re right. That’s exactly the hack. So, even before COVID-19, I should have brought it with me. I had a high-altitude mask I was using to train because I found that, you know I actually didn’t have a very strong foundation of aerobic fitness before. I was more of a HIIT type athlete. I did a lot of stop-and-go type sports. But I found that just by wearing a mask, a high-altitude mask, I was able to improve my aerobic fitness much more quickly exactly by what you said by mimicking that low altitude or that high-altitude environment. Because in that environment, because you’ve got thinner air, your bone marrow produces more EPO, you produce more red blood cells, your oxygen delivery capacity goes up. So, that’s literally what you’re trying to do through aerobic fitness, so you don’t switch on those dangerous chemicals that shift you over to anaerobic metabolism and you know lactate production.

 

Dr. Z: So, and last time we talked, we spoke a bit. And this was in the early days of the thing. We spoke a bit about how metabolic syndrome, being in bad shape, for lack of a better term, sets you up for a kind of pyrogenesis, a fire creation of inflammation that is really felt to be one of the big problems in COVID. Now, again, we’re not, these links haven’t been elucidated clearly, but we can theorize and say, okay, well, what’s the downside of addressing this through being in better shape, eating better, improving your metabolic health. Those would help you anyways. So, if it also helps you not die or get very sick of COVID, that’s an added benefit, right?

 

Dr. Sinha: Totally agree. And this word we keep bringing up, mitochondria, when you look at insulin resistance, we’re finding that a lot of these chronic health conditions are defects of the mitochondria. It just cannot produce energy efficiently. So, even pre-COVID, we know that individuals that have insulin resistance, their mitochondria is impaired. It just can’t produce ATP at the right level. So, then when you’re eating even normal to elevated amounts of carbohydrate, if it can’t get to the mitochondria and produce energy, it’s gonna sit in the cytosol, it’s gonna cause all types of other damage. The mitochondria is so pooped out that basically it’s producing these toxic radicals that are further damaging the cell and making insulin resistance and inflammation worse. So, it’s really you’re right. Taking that same disease template for cancer, diabetes, and heart disease and allaying it onto COVID-19. Because like you said, there’s so much overlap with those conditions and COVID-19.

 

Dr. Z: So, is this similar to a Jason Fung sort of algorithm where the idea is that we’re really just packing a lot of glucose into people that don’t, can’t use it in their mitochondria and it’s causing this problem. Yeah.

 

Dr. Sinha: That’s right. So, I think there has been a lot of focus on the input in terms of how much food are we shoving in our face you know throughout the day. And I think that’s really important. But I gotta say after doing this work for over a decade, now what I’m finding a lot of my patients is even though they have clung to fasting, low carbohydrate ketogenic strategies, I’ve seen dramatic improvements in their numbers. You know what I’m seeing is, because I follow these patients for so long, they’ve been sedentary overall for so long that after age 35, after age 40, even though they’re doing the same sorts of fasting diets, we’re starting to see the signs of prediabetes. And the reason for that is because even though the input has been reduced, the mitochondrial output has not been enhanced. And that’s where exercise and aerobic performance is essential. Because literally with aging, just like the condition sarcopenia where a muscles become a little bit weaker as we age, I call this mitopenia, where our mitochondria with each year of aging, our mitochondria naturally start to age. So, they can’t handle the same inputs of food. So, if you literally want to slow down aging, yes, you have to slow down the input of food through fasting and just proper nutrition strategies, but you’ve also gotta enhance the mitochondria’s ability to take that energy. The throughput basically is what I’m talking about. And I think a lot of people, I have a lot of patients that seem easy and they basically do not wanna exercise. They wanna do everything. They would fast for 24 hours then go exercise for 30 minutes. And I’m like, that’s just not gonna win in the long run. You have to fix the mitochondrial issue or you’re not gonna be able to avoid all these chronic health issues and COVID-19 serious responses.

 

Dr. Z: So, really what you’re doing is you’re addressing both sides of the equation, the input and the throughput. It’s kinda like in the ER, when we’re on divert, right? All the beds are full, the ER docs maxed out, we’re understaffed, the nurses are going one to eight. And you just can’t process it. And as we get older, the analogy then is our mitochondria are kind of like that. They’re like an ER on divert. So, either you can improve the amount of patients coming in by decreasing it, changing your diet, or you can build another wing or enhance your current wing in your ER. And you’re talking about exercise as a way to do that. And again, this all relates to COVID because again, mitochondrial function may correlate to the way COVID causes havoc through whether it’s inflammation or whether it’s the the HIF-related energy mismanagement, et cetera.

 

Dr. Sinha: That’s right.

 

Dr. Z: Yeah so, how do you then talk to your patients about exercise? How do you do it?

 

Dr. Sinha: So, then when I see patients, and many of them, like I said, have adopted sound nutritional strategies. Others have not. You Know, this has been a very tough time. People are stressed out. They’re baking and they’re ordering and they’re stress eating a lot. Which is understandable, but then I’ve gotta weigh those things. So, if I have somebody that has been doing the right things from a dietary perspective, but they become increasingly sedentary, I have labs to see from before and after. And I’ve seen the trend lines where their glucose numbers are going up, their inflammatory markers are going up. So these are subtle signs to me that their metabolic function is deteriorating despite them doing the right dietary thing. So, then I have to talk to them about sound exercise strategies. How can we boost that mitochondrial function. And others, unfortunately, some of them were actually exercising more than ever because they’re not sitting in cars commuting. They’re not traveling on business. The diet hasn’t been quite optimized, so their throughput’s okay but they’re putting in so much food into the system that we’ve got, really what scientists call the situation is metabolic gridlock. There’s like traffic gridlock inside the mitochondria. The mitochondria cannot handle that input. So, you’re right. You gotta balance that input and the throughput as well. But you look at metabolic markers, you take a good history and you can kinda see where we need to sort of put the emphasis. Ideally on both, but some people that just have to focus on one thing, I try to find out what’s the thing that we can optimize first.

 

Dr. Z: And one question I wanted to ask you is when you have mismatched too much and can’t get the throughput, that glucose goes to fat, correct?

 

Dr. Sinha: Right.

 

Dr. Z: Intraabdominal fat is the worst sort of storage capacity for that. Can you talk a little bit about the consequences of where that glucose goes?

 

Dr. Sinha: Yeah, good point. So, when the glucose can’t get inside that let’s say muscle cell, you’ve got this overflow glucose traffic. And some of it, for example, will go to your liver. And the liver can produce triglycerides, extra hyperglycemia, glucose is being basically pumped up by the liver. And the fat, you’re right. For a lot of us, it goes not just a fat itself but that belly fat, that visceral inflammatory fat. And we talked about last time how that visceral fat produces a lot of the cytokines compared to the other compartment. So, again, that’s making your cells and your body more flammable. So, if it were to get infection, that cytokine storm might be more significant. And that’s there’s a bit of a genetic and also an ethnic link. Like some individuals like Asians and Indians like ourselves, if we get into that overflow situation, a greater proportion of that traffic will go to visceral fat versus certain Europeans or Caucasians where yes, some will go to visceral, but a lot of it goes to the subcutaneous fat. So, they’re gaining more mass in terms of poundage, but they’re not getting as much going into those visceral compartments. And that’s a tricky thing because a lot of Asians or people that have this insulin resistance paradigm, they are socking away that hidden fat. They’re not gaining a lot of weight, but maybe an inch or two here. Maybe their liver function tests are trending up, which is a sign that the liver is becoming overwhelmed. So, you can pick up on these subtle clues in people that have that visceral tendency.

 

Dr. Z: So, you’re getting this sort of non-alcoholic fatty liver disease in these guys where it’s just depositing. And you had termed this in your book, skinny fat.

 

Dr. Sinha: Yeah.

 

Dr. Z: And it’s this idea that you don’t look like a lot of Asians, like my wife or her family. Skinny, skinny, skinny, skinny, skinny, but they, like my wife had gestational diabetes and even though she’s rail thin, her dad is rail thin, he has almost frank diabetes now. And I suspect there’s intraabdominal obesity. There’s some genetic component too. But he eats a very high fruit diet and there’s a lot of fruit sugars and things like that and not a lot of exercise.

 

Dr. Sinha: Yeah. Yeah. And it’s really an imperfect storm. So, one of the thing I’m seeing, again, speaking of COVID-19, some of my seniors, in addition to that excess visceral fat, and again, we talked about liver function tests, the other thing is sometimes we’re seeing C-reactive protein go up, which is a marker for inflammation. Often we’ll see the triglycerides go up, which is a sign that the liver has been overwhelmed. So, these are internal markers that we are accumulating more fat rather than the poundage or the body mass index. The other thing that I’m seeing just from the excessive inactivity, and I’m seeing this a lot in my seniors is that they’re losing muscle mass, right. And if they’re losing muscle mass and strength, again, coming back to mitochondrial throughput, it’s an imperfect storm, right? Increased input leading to visceral fat formation. And then you don’t have the muscular strength and the physical activity to really burn that energy and get rid of that. And that’s something I’m seeing a lot of because people have been so incredibly sedentary during this time

 

Dr. Z: Could there be a component that then would explain the predisposition of COVID to hurt older people in that they have less mitochondrial capacity?

 

Dr. Sinha: I think that’s one of many things. As we know, the immune system deteriorates. We talked about mitochondrial function. But yeah, if you add sarcopenia and reduce leg strength, whenever I talked to my mom, she lives in Central California. I’m gonna be seeing her next week.

 

Dr. Z: So does mine.

 

Dr. Sinha: Oh really? Bakersfield

 

Dr. Z: Yeah. Yeah. Yeah.

 

Dr. Sinha: I think we had-

 

Dr. Z: Fresno.

 

Dr. Sinha: Yeah, Fresno exactly. Yeah. And so, whenever I see her, and she knows when I’m coming, because she’s like, “Oh God, Ron’s gonna be evaluating me.” But I’m always checking, “Mom, let me see you get out of a chair without the armrest. Are you doing your squats?” I’m constantly assessing. I do this with my seniors. I’m constantly assessing her leg strength. When I go for a walk, for her, it’s a casual walk, but I’m actually looking at her walking speed. Is she able to get up on curbs okay? Because I’m constantly monitoring is she maintaining that muscle strength? I mean, obviously it’s important for aging. I mean, there are studies that show that leg strength is probably one of the most important indicators of long life and quality of life, more than anything. It even impacts the brain health. But in addition to that, in this environment, I want her metabolism to be sound, so leg strength is just so important to me.

 

Dr. Z: Hmm. It makes a lot of sense. And I think, again, if you’re talking about preparing for the COVID marathon, right? And this is our highest risk population, the sarcopenia, the leg strength, the sort of the ability to do your ADL’s too, is probably a predictor just in terms of how deconditioned you’ll get, what your lung capacity is. But let’s talk about now, let’s say the average, let’s say a 30 to 40-year-old person who gained the pandemic five or 10, and is constantly under some low level of stress, whether it’s due to neurosis and worry about the pandemic itself, which is a self-defeating, self-feeding prophecy. There’s a lot of cognitive distortion and catastrophizing that we do. And there’s cortisol and there’s stress. How are you seeing that feed into metabolic disorders that put us more at risk for actually getting ill when we get the disease?

 

Dr. Sinha: Yeah, so, I mean, I think there’s indirect links because when people are under that cortisol onslaught they’re not making the proper decisions about lifestyle, right? I know when I’m stressed, I’m not craving broccoli. I don’t feel like fasting. And you just wanna eat everything in front of you. When you’re feeling overwhelmed, the last thing you think about is stepping out and exercising. So, indirectly it leads to that. But we also know that people that do tend to be in this sort of storm of emotions and especially if they’re really storing those emotions in their head and ruminating quite a bit, that actually causes an increased immune system response from that. So, a study that they showed where they actually gave questionnaires to individuals and they found that one group tended to do more natural cognitive reframing around stressful situations and scenarios versus individuals that are ruminators. They found that ruminators actually produced more cytokines. And they knew that because it can measure it in the nose after exposing them to cold virus. This is not surprising to you, but it’s direct evidence. So, I tell people, this is a catch word that I use, instead of immunity, I want you to think of “emmunity” because your emotions affect your immune system. And when you look really calm, cool, and collected on the outside, and I know this because I’m a recovering ruminator. I still work with this a lot, but a lot of my individuals that are very calm and serene-looking on the outside, your immune system knows everything that’s happening inside. So, when you’re repressing and suppressing emotions, whether it’s fear about your mom, yourself, your children being distant-schooled, you may be able to hide that to people around you who think, “Wow, how’s he handling this?” Your immune system knows all your dirtiest secrets. It will react. It’ll produce cytokines and cause physiological changes. And I wouldn’t have believed this 10 years ago but after looking at all the data in science, it’s pretty compelling what it can do.

 

Dr. Z: Yeah. Adept meditators have been saying this for a long time.

 

Dr. Sinha: Yes. Right.

 

Dr. Z: That the body keeps the score. Like what you deny, the body unconsciously is telling you already. And so, all of this, yeah. Like you said, this rumination, it’s not just in the mind. The mind and the body are one continuum. And I’ve noticed this, and you mentioned being a recovering ruminator. I’m a continuous ruminator. That the only thing that has helped me has been meditation and a little bit of getting older. And meditation’s remarkable because you can watch yourself ruminate. And now what happens is, it’s just happened in the last few months is I get into these thought patterns where, and this is kind of an aside, but I’ll get into a thought pattern where I’ll start going down a ruminatory path where something negative, a negative emotion pops up. I then have a thought that arises that puts some meaning to the emotion. Like, “Man I’ve gotta go and do this, this and this and this and that, the other thing and this. Oh my God, I’m worthless.”

 

Dr. Sinha: I hear you.

 

Dr. Z: And it starts to spiral. And then normally I would get pulled down that path and you can feel it, right? You feel it if you pay attention. You feel it in your chest. You feel butterflies in your stomach. Your mood starts to change. You cut off the conversation you’re having with your daughter and start ruminating a bit. Maybe you open your phone up.

 

Dr. Sinha:  Oh man.

 

Dr. Z: But we know what happens-

 

Dr. Sinha: And my heart beat’s going up just listening to you because I can connect to this.

 

Dr. Z: Isn’t that crazy?

 

Dr. Sinha: Yeah, right. So, yeah.

 

Dr. Z: You and I are very similar. We’re these immigrant children in the Silicon Valley. And we’ve talked about this. But you know what’s crazy is now what happens is I see it happening from a one step back, like a witness position and going, “Oh look, I’m starting to ruminate. Oh, this silly mind. Look what it’s doing. Stop. Let’s think about something else.” And it aborts. For the first time in my life, I’ve been able. And I have to attribute that 1000% to sticking with meditation for the last eight years. Just plodding away at it, and all of a sudden you start to notice the benefits.

 

Dr. Sinha: Yeah. Agreed. And you know what, for a lot of the techie companies that I lecture to, as much as I talk about ancient science and meditation you know for a lot of people it’s very woo-woo science, right?

 

Dr. Z: Oh, heck yeah.

 

Dr. Sinha:  But the good news I have is for a lot of left-brainers, including myself, we have functional MRI studies where they’ve put individuals through the exact process you’re talking about. And they put them through emotional situations. They light up the brain and they can see, is this the emotional part of the brain being active or the cognitive, the frontal cortex, the more rational and part of the brain. And we definitely want our emotional brain to be active. We’re not robots here. But you don’t want it to become overactive. And one study I’m gonna quote for you which was compelling to me, was a study done at UCLA by Dr. Matt Lieberman. And they basically use functional MRIs in people that were having stressful situations. And all they asked them to do was write down that thought in let’s say two or three words. So, we call it thought labeling. And the minute they wrote down that thought, and actually give me one second.

 

Dr. Z: Yeah. Yeah. Yeah.

 

Dr. Sinha: I have some post-its here. When I take a complex emotion and you can really just write it down in two words like that, right? Like really angry, right? Or extremely jealous, right? So anything, right? Worried about mom, right?

 

Dr. Z:  Put one up. Put one up. Put one up.

 

Dr. Sinha: Worried about mom or whatever. Just the physical act of writing down that thought in two or three words, it literally reduces the activity of the amygdala and the emotional brain and it basically lights up the frontal cortex. So, we got extremely jealous. Whatever you wanna write down, just that process because when you can take… Right.

 

Dr. Z: This is…

 

Dr. Sinha: Right. So, it’s incredible. So, as a result of that study, what I started doing, and I’ve gotta say, I’ve been very erratic about this in the past, but for the last few months, I’ve journaled like nobody’s business. When I get up at 2:00 or 3:00 in the morning, I go into the closet. I brought my journal here. And it is just full. I’m not gonna read my journal to you.

 

Dr. Z: Yeah. Dear diary, today, I’m gonna see ZDoggMD. I think he’s a total hack, but I’m gonna pretend to be nice.

 

Dr. Sinha: What a waste of time.

 

Dr. Z: Yeah. .

 

Dr. Sinha: Yeah totally. But really, but and I’ve gotten patients that were naysayers about this to do that. And a lot of times they’re perfectors they’re are like, “Well, I’m not a writer.” I’m like, “Just write everything down that you feel.” It is one of the most therapeutic things you can do. The number of studies out there in journaling are incredible. But I’ve found that it’s helped me sleep better. I can cognitively just focus much better on my tasks. But even if you’re like in an office and you don’t have access to a journal, just write it down. If you’re afraid people are gonna look at it, toss it up, tear it up, put it in the shredder. But just get in the act of writing it down. And the reason why writing it down in just a few words works, is because you’ve done a lot of public speaking, right? So, when people ask me to give an hour talk on metabolic syndrome, it’s pretty easy, but when they ask me to do it in 10 minutes, that’s really tough, right?

 

Dr. Z: Oh, yeah.

 

Dr. Sinha: So, anytime you take complex emotions and situations and you can synthesize it into just a few words or a couple of sentences, that already turns on that Einstein part of the brain, the frontal cortex and that will automatically tame down the emotional brain. So, the writing, whether you have a journal or not, if you can just pencil it down somewhere, some people have told me, “Can I type it into a computer?” Even that’s better. I prefer the act, the physical act of writing it. And sometimes I’m writing my papers like tearing because I’m upset about something, but it’s a release. So, I think that’s something we can all try to at least incorporate.

 

Dr. Z: This is huge advice. And the CBT people, the Cognitive Behavioral Therapy people have been talking about this for a long time to write down your thoughts and then recognize the distortions in the thought. And the way I like to think about this is, as we use this analogy on the show, the elephant and the rider, the elephant being the emotional brain that’s ancient and old and automatic and highly conserved evolutionarily like we share it with animals. And then you have the rider, the little guy on, the little Indian dude on top. That’s like riding the elephant, “Come on, come on, go buddy.” And that guy is our rational thinking frontal cortex, neocortex, et cetera. And the thing about that guy is, in most cases, he’s a slave to the elephant. He exists to serve the elephant and to convince others using his verbal abilities that our elephant is correct. But in the best of us, we can grow his role and writing things down, journaling, recognizing cognitive distortions, recognizing when an emotion triggers a dysfunctional thought where the writer starts to spin his wheels and go down these paths that release cytokines and get you COVID, being able to do that allows the writer to grow, our critical control, like you said, to grow. FMRI data, then bears that out. So, all of this ancient wisdom, collides with modern understanding to give us a framework on, because the real question is how do we live better? And I think that’s a way. We’re less anxious. We’re happier. We’re more connected to our loved ones. We’re less likely to die of an inflammatory cytokine storm.

 

Dr. Sinha: Right.

 

Dr. Z: I think. And our blood pressure is lower. And have you seen that bear out in your patients?

 

Dr. Sinha: Yes. Thank goodness, yes. I mean, people that are doing these sorts of techniques, and one of the things I tell them is I know it seems overwhelming to do this, but even if we can do it, especially if you’re suffering from sleep issues, if you can do it in the evening, just like a few sentences, a couple of paragraphs before bedtime writing down these worries and concerns, people do sleep better. And one of the biggest connections I’m seeing with blood pressure is sleep dysfunction. When people sleep better, we see their heart rate, if they’re wearing an arm ring or an Apple watch or monitor, we see their average heart rate overnight actually starts to drop down because we’re able to release a lot of those thoughts and emotions. And when you actually get better quality sleep during the night, the downstream effects throughout the day basically. You see lower sympathetic responses, heart rate, blood pressure, everything gets much better. So, we see that over and over. And sorry, real quickly, I’m seeing more and more teenagers. And interestingly, I’ve never seen high blood pressure in teenagers since I started. We’re seeing a rise in that now too. And I’m hearing from pediatricians. And a lot of it is really stress responses like this. So, they benefit a lot from being able to release some of that energy before going to bed. Even pulling their bedtimes back for an hour, we see incredible responses just from doing that.

 

Dr. Z:  We’ve been advocating for letting kids sleep for a long time. And teens tend to go to bed later which means we ought to be starting school later.

 

Dr. Sinha: That’s right.

 

Dr. Z: And to some extent, it’s been nice that the kids have been homeschooled recently. The only nice thing is that they sleep in a little bit more.

 

Dr. Sinha: Sure.

 

Dr. Z: And so, they have that little bit of regulation. So, sleep dysfunction, so we talked about a few things that we can practically do. So, one thing is journaling, writing down emotions, buy a watermelon and stuff a persimmon in it.

 

Dr. Sinha: This is like a Turducken or whatever they call it.

 

Dr. Z: Oh yeah, Turducken.

 

Dr. Sinha: That can be a word.

 

Dr. Z:  Yeah, it’s a turkey with a duck with a chicken in it. That’s right. It’s a persimmon with it. You need a pickle in there somewhere to represent the sarcoplasmic reticulum.

 

Dr. Sinha: That’s right.

 

Dr. Z: So, let’s talk about some specific things that our audience can do then to sort of tune themselves up because now we have this chance, it’s a reset 2020. It’s like, oh, everything we thought was true about the world has been like deraveled. And the stress and the… Oh, we gotta talk about kids in school at some point here. But what are some, give me some action items. We talked about journaling. What about these sort of you talked before on our show about breathing exercises, how can people start to get active and make that mitochondrial throughput better? What’s the-

 

Dr. Sinha: Good point. So, with the breathing, well, let’s come back to breathing. So, we talked about aerobics function and resilience. And definitely one simple technique, and it’s become very popular because of a book called “Breath” that came out by James Nestor. And literally the art of nasal breathing has been around for so long, but I’ve gotten a lot of my patients just to pay attention to how they’re breathing when they’re in front of screens. So, one thing that a lot of people don’t realize, and this is something I give in corporate talks is based on one anecdotal study about two thirds of us when we’re in front of a computer and we’re composing an email message or responding to a message, we stop breathing. So, this is an entity some have called email apnea. And it’s true.

 

Dr. Z: Really? That’s a thing?

 

Dr. Sinha: That’s right. It’s incredible. Yeah, so apnea, obviously not breathing, but when you pay attention to how your breathing is when you’re looking at texts and electronic media most of us are underbreathing or we stop breathing. So, what kinda response does that… Yeah, look at you you’ve stopped. Your body’s not moving at all, Z.

 

Dr. Z: Dude, I nearly coded just checking Twitter.

 

Dr. Sinha: I was about to reach across the table.

 

Dr. Z: Yeah, you start like pumping on the chest, right?

 

Dr. Sinha:  Now can you tell me more? But I mean, if you’re spending 12 to 14 hours in front of devices all day and you’re literally underbreathing, what do you think that, what kinda signal is that sending to the body? Right? I mean, oxygen is the stuff of life. And if we’re not getting enough of it to our tissues, that’s gonna cause a stress response throughout the day. So, literally even if you’re looking at that same message, that piece of media, and you can slow down your breathing by doing nasal breathing or just calm that breathing, if you do that, you’re gonna start seeing that it’s not gonna affect you as much. It’s not gonna have the same sort of response. When you exercise, if you can train yourself even you go for a power walk, you just nasal breathe, it’s much more calming afterwards. And as you get fitter and fitter, you’ll be able to increase the intensity of your exercise while you’re nasal breathing. So, that’s one thing. The second thing related to breathing, and you totally picked on me for this one, but it is nasal humming. If that’s so, right?

 

Dr. Z: Oh, yeah that’s right.

 

Dr. Sinha: But one thing is okay, if there’s one molecule which I know you’re very familiar with, it’s nitric oxide, right? The most potent vasodilator in the body. And when we nasal breathe and nasal hum, we’re actually causing more nitric oxide production from the paranasal sinuses. That’s about where 20% of nitric oxide is released. And nitric oxide is fascinating because it has antiviral ability. So, it literally kills COVID on the spot and reduces viral load. It lowers the cytokine response. We know the incredible benefits it has on our lungs, basically in terms of being a bronchodilator, it opens up the airways. So, the more we can get our body to produce nitric oxide, I would say it’s probably one of the most important molecules in really increasing our resilience to COVID-19. So, these are some things. We can start with the breathing and some of the physical activity.

 

Dr. Z: And how about getting moving when you’re say working from home or something’s changed, what are you telling your patients?

 

Dr. Sinha: So, the first thing is if we can get from sitting to standing more often, that’s a start. But then what I’m really trying to get people to do is in all our meetings, we’re not always on video. So, some Zoom meetings, we’re not on video. So, a lot of people can’t see the fact that I’m doing a couple of squats while I’m listening to somebody give their presentation. So, these micro movements in between meetings or during meetings, these can be powerful for your body. These are gonna be powerful for your body to actually burn more fuel and prevent that metabolic gridlock. Because you know what a lot of people do, Z, is they’ll do like a 30-minute or an hour exercise session in the morning or the evening, but then they’re sitting continuously. And again, I credit them for doing that exercise session because that has a lot of downstream benefit. But if you’re not really integrating that interrupted movement and activity throughout the day you’re really not boosting that metabolism in the long run. So, that’s really what you wanna do. So, that could be you doing a couple of squats. That can be you. So, this is a fabric resistance band that I have here. Can you see that?

 

Dr. Z: Yeah.

 

Dr. Sinha:  So, sometimes I’ll stand at my standup workstation, I put this around my thighs and what I do is I just gently put the legs apart so I can put some core activation and have my glutes basically activated as well too. So, just being in that posture can get those larger muscle groups moving. So, even when you’re in a static position, there are things that you can do in the course of a meeting that keep your body energized. So, these are the creative things I want people to start doing where it’s not all or nothing. Either I’m gonna go out and exercise like crazy, or I’m gonna sit like a log in front of the computer hunched over all day.

 

Dr. Sinha: Not, breathing. Yeah.

 

Dr. Z: So, this is very valuable because what you’re talking about is engaging the largest muscle groups in the body, the big muscles of the leg and the butt and these things that are big sinks of glucose. If you use them and also if you generate more muscle mass there, your baseline metabolic usage is higher. Your throughput is better. And it’s just putting an elastic band and doing that while you’re sitting on a Zoom call, turn your video off. This is something I’ve been telling people. Because look you can just say, “Hey guys, I’m just gonna bug out on the video because I got a kid running around,” even if you don’t.

 

Dr. Sinha: Yeah.

 

Dr. Z: And just go audio-only. And what that does, it allows you to do those things, to stretch, to pace, to stand up, to walk around. It’s the substance of life for me because I’m so fidgety. I have to do it. But I tell you because otherwise I might just sit all day. And again, all the sitting is dangerous.

 

Dr. Sinha: Yeah.

 

Dr. Z: We don’t teach that enough.

 

Dr. Sinha: And the shift that you’ll notice when your metabolism goes up, is when your metabolism is slow, it takes a lot of effort for you to actually even stand up. You feel like a pile of bricks. So, when I tell people to do this initially, because again, their dietary inputs are too much, they’re not used to this, they literally have to set a timer on their phone or their screen to remind them to get up. But once you get in the habit of doing this, the opposite happens. Like sitting for more than 30 minutes or 20 minutes seems unbearable. So, you naturally become fidgety. That’s a sign that your body is burning glucose and fats more efficiently. It’s a subjective sign that your metabolism has now gone from sedentary to more active. It’s a beautiful thing. And now if I asked you, “Hey, Z, let’s go for a hike right now.” Your body’s already revved up. You don’t have to go through an artificial, “Let me have a cup of coffee first and stretch for an hour.” You’re revved up and ready to go. And that’s what I want people to feel throughout the day.

 

Dr. Z: Yeah, I’d come up with 13 different reasons why I can’t. “My chronic Lyme disease. I don’t wanna get another tick bite because it would just kill me.” It makes me think, and this is speculation because you’ll give me science and then I’ll throw a speculation at you because I’m basically Dr. Oz at this point.

 

Dr. Sinha: We got that on record. Yeah, right?

 

Dr. Z: Oh, by the way it was really funny. So, there’s this woman, Christiane Northrup, who has gone viral on Facebook, talking about anti-vaccine stuff and how nanobots are being injected and Bill Gates is keeping track of, for us to connect us to cryptocurrency.

 

Dr. Sinha: I just stopped breathing by the way. But keep going.

 

Dr. Z: Yeah.

 

Dr. Sinha: So, keep going.

 

Dr. Z: And the way she appealed to authority in the beginning of a video, I’m gonna do a debunking video after this. But the way she appealed to authority was she said, “Now I am an obstetrician. And I have been on the “Dr. Oz Show” and “Oprah” many times. And I’m like, “So there’s your credentials.”

 

Dr. Sinha: Credentials, right?

 

Dr. Z: How about that?

 

Dr. Sinha: What a pedigree!

 

Dr. Z: How about that? But so here’s the question. So, you talked about this feeling of being revved up and ready to go, but then the opposite of that, which is that feeling of, I feel like I’ve been hit by a truck or I’m just not feeling it. People who get a big viral syndrome with cytokines, like COVID have this description. “I’ve been hit by a truck. I can’t. I’m de-energized. I have muscle aches.” Do you think some of that has to do with this change in energy metabolism that you’re talking about?

 

Dr. Sinha: I think that’s a great point. I’ve thought about that as well, too. And I think people that already exactly have that metabolic inertia even pre-COVID, I think they are more susceptible to getting that. It makes sense from an energy system point of view. I don’t have the science to back it up, but I think that transition does become much more natural for people that are more inert by nature.

 

Dr. Z: Have you heard about this bradykinin hypothesis with the cytokine storm?

 

Dr. Sinha: A little bit, yeah. Yeah.

 

Dr. Z: A little bit. They’re saying bradykinin is one of the cytokine components that is causing this. And it makes me wonder because again, type 2 diabetes, metabolic syndrome, obesity, these seem like really clear independent risks.

 

Dr. Sinha: Absolutely.

 

Dr. Z: And it ties into your approach on this. Which is, again, this is a high degree of metabolic inertia. I like that. I’m gonna steal that. Metabolic inertia. It’s very hard to get those mitochondria revved up to utilize glucose appropriately. And all of that is at least partially manageable with lifestyle.

 

Dr. Sinha: That’s exactly right. The other thing that’s a bit of a paradox, I’m gonna throw a curveball ball at you, is despite me doing this work in, like I said Asian and Asian-Indians that are at a high risk for that, if you look at the population in India, there’s something called the Indian enigma around COVID-19.

 

Dr. Z: Yeah, tell me about-

 

Dr. Sinha: Have you read about that?

 

Dr. Z: Yes.

 

Dr. Sinha: So, and I’m seeing this in relatives and people that I know in India where they’ve got like they’ve gotten COVID-19. I’ve got multiple relatives and distant relatives that have gotten it. And you would think, Z, that if they’re in the US they would have been in the ICU because they’re morbidly obese, they’ve got diabetes. I’ve got some relatives that are above the age of 80 and they’re getting through it fine. So, this tells us yes, metabolism is a big part of this. Insulin resistance is linked. But what’s going on there, and that basically comes back to the immune system. Is there something around the hygiene hypothesis where us purelling ourselves head to toe and not being exposed to microbes in a natural way, is that having some sort of impact. It’s funny. I was telling someone from my team and she was like, “We need to bring back open defecation. That’s what we need to do.” Right? I was like that’s over the extreme.

 

Dr. Z: Oh, but sure. I’ve advocating for throwing feces in the street for like years, Ron. I’m glad finally, a scientist has come to my defense on this. This hygiene hypothesis thing is fascinating. Because again, you look at like the Mumbai slums 60, 80% positivity on antibody tests, death rate very low. And it speaks to it because not like Indians are without metabolic disease. Like you said, some of them have obesity and so on. It is there is an immunological component. And I do wonder whether they’ve been naturally exposed to Coronaviruses that we haven’t and they’ve generated a T cell memory response that keeps them a little more safe.

 

Dr. Sinha: Yeah, I mean, their immune system has faced an onslaught compared to what our immune system does, right? So, their immune system is literally looking, “Oh, you’re gonna throw another one at me. I’ve been here before. I know what to do.” But for us, it’s like, “Oh my God, what the heck is this?” The immune system revs up. It overreacts. It goes crazy. So, we talked about metabolism but this is where components of the diet are important. Because one of the things I’m worried about is a lot of my patients that are over fasting, like many of them are fasting like crazy, because number one, they know it’s good for their health, but they’re also stressed and don’t feel like eating. So, they’ve lost a lot of weight. And when I look at what they’re eating throughout the day, it’s not a lot of food. They’re nutrient-deprived. They’re not eating a diversity of plants. There’s this whole microbiome part of the immunity in the gut that’s not happening. And I’m telling people that despite me doing this work and me probably edging on the side of undereating, I’m actually betting on all types of fruit. I would rather overeat a little bit during my eating windows now and just diversify the amounts of plants that are in my system so I can upgrade my immune system rather than undereat. Because we know when you’re having protein deficiency, you’re losing muscle mass, all that stuff compromises immunity. So, just be aware of that because many of my patients are over obsessed on the fasting trend. They’re trying to lose a lot of body fat, but the meantime I’m afraid that they don’t have the diversity in their microbiome to really support adequate immunity during this time. And this is something maybe the Asian-Indians have because they are eating a diversity of different plants, are exposed to microbes. Their natural immune system is more resilient than ours is.

 

Dr. Z: Man, there’s a lot in what you just said that I think you could spend a lifetime researching. Because the microbiome is one component that is affected by your diet, your exposure to natural microbes. And on top of that, this idea of eating in a narrow window which I do as well, I’m a one meal a day kinda guy, but I’ve also expanded. Like I used to avoid carbs and do all of this. Now what I do is I have a lot of whole grains, a lot of olive oil, a lot of avocado, much less meat, and a diversity of plants, like you said. So, it’s nutrient dense, but classically, I would have thought, “Oh, I’m gonna start getting insulin resistant and gaining weight because that’s what’s happened to me in the past. But the difference is with the narrow window and incorporating the fats that slow the general absorption of the grains it’s worked really well where I’ve actually lost some weight despite feeling really full and kind of eating like a pig during that window. If I’m being honest, I’m just like, “Give me a low for this Walnut bread.” And I’m just gonna eat half of it and pour olive oil, like unlimited amounts of olive oil, and it seems to work. My blood pressure’s good. I checked my sugar just for fun because I’m kind of a quantitative guy.

 

Dr. Sinha: Yeah.

 

Dr. Z: It’s been fine. So, it’s really interesting.

 

Dr. Sinha: And I’ll tell you, because I have so many patients on continuous glucose monitors, aka CGMs, many of them that have taken the strategy on, even though their carb load has gone up, their glucose control has been great. Because I tell people when you eat some healthy carbohydrates like let’s say a small serving of lentils or starchy vegetables, the immediate response is gonna be a spike. But we can’t keep overreacting to that immediate response because the downstream long term effect is if you’re feeding the right bacteria in the gut, long-term wise they’re gonna metabolize sugars and fats. So, I tell people, it’s like if you’re doing the stock market, you have one price spike, you’re not gonna sell or you’re not gonna overreact. You wanna look at the overall market trends. It’s the same thing with these foods. Yes, there might be a transient glucose spike, but then when I follow them for several weeks or few months, despite them eating maybe 50 grams or 100 grams more of the right carbs, their overall glucose control is excellent. And I can bet if I were to check their microbiome, it’s much more diverse and their immune system is probably stronger too.

 

Dr. Z: And I think this is where we start getting into artificial sweeteners and things like that, that I think may alter that microbiome. So, even though they have no calories, they do a number on your natural gut flora and that changes some things. And again, we don’t fully understand it’s an active research area, but man, it makes you think because we’re just scratching the surface of the complexity that is this constellation that is us. And we share it with these animals basically. It’s really crazy. That’s another thing this Christiane Northrup woman was saying in her videos. “We’re creating chimera.” She said chimers because she doesn’t understand science. So, I’m gonna translate it. “We’re creating chimeras with foreign DNA.” I’m like, woman, look in your gut. Look how much DNA. Look at your own genome. Viruses, retroviruses for millennia have incorporated themselves into as part of our DNA. It’s how we are connected to the natural world in a way that is so actually beautiful. When you come to think of it, it will make you weep. It’s so beautiful. And we kind of totally dismiss it. It’s us versus nature.

 

Dr. Sinha: Yeah.

 

Dr. Z: Yeah.

 

Dr. Sinha: Yeah, absolutely.

 

Dr. Z: Yeah. I wish I could say something nice about COVID, but I can’t except that probably will generate some community immunity at some point through a vaccine and through natural exposure that will then rev up our immune system against this classic.

 

Dr. Sinha:  Yeah, and I think it’s teaching us some skills. A lot of my patients that were very dependent for example, on going to fitness centers for fitness, I’ve been telling them all along before COVID, that many of them are overdoing their exercise.

 

Dr. Z: Yeah.

 

Dr. Sinha: Coming back to anaerobic sort of-

 

Dr. Z: You don’t hear that from a doctor very often. “Hey, you’re exercising too much. This is such a Bay Area thing. Buddy, cool it.”

 

Dr. Sinha: Totally. But what they don’t realize is 80 to 90% of their workouts are in that anaerobic zone. So, what I basically outlined for you is when your immune system or when cancer cell has experienced in anaerobic metabolism, that’s an alarm flag for the body, right? That’s an alarm system that produces cytokines. Now, if you’re somebody that’s training for half marathon, you’re jogging at a high heart rate because a lot of us might think we’re in that aerobic metabolic zone. We’re not. 95% of patients that come in, when I strap on a heart rate monitor or tell them to wear a polar or an Apple watch, I tell them, “Send me your data or share it with me a week later,” none of them are exercising within the optimal heart rate window. So, they don’t realize that 80 to 90% of their workouts are in that anaerobic zone. And that is not good. Because over the long-term, that can generate calcification in your arteries. It can create more inflammation. It’s sort of that exercise curve where yes, enough of it is great for longevity, but when you fall off that cliff, then all of a sudden you get these issues. And so, one simple rule of thumb, and actually did my own little podcast interview with this guy, he’s an exercise physiologist, is a 180 minus your age threshold. It’s called the Maffetone heart rate. So, you’re 40 years old, 80 to 90% of your workouts should be within 140. Not beyond that. But most of my patients are in the 160-plus zone when they’re running and training for half marathons. That is such a critical zone because once you get beyond that zone, you’re no longer training the mitochondria, you’re really more within the anaerobic window and that can generate a lot of inflammatory byproducts.

 

Dr. Z:  How interesting! So, because a lot of times now as I get older, I’m 47. So 180 minus 47, it should be 133. I find that I sit in that pocket when I’m exercising at home on a StairMaster or treadmill. But when I get on my bike and I’m climbing hills I’m 160, 170 and just it’s pounding. And I feel good. I feel… But it’s funny when I do those exercises for the next few days, I don’t feel so good.

 

Dr. Sinha: I love you. See, this is why I love you. You have so much self-awareness because when you’re in that zone for most of your workouts, the reason we love it is because we’re hooked on adrenaline. It can feel good after that. But studies have shown that when you’re in that zone for the next 24 to 48 hours you’re gonna consume probably 30% more carbohydrates. Because literally again, coming back to watermelon sugar-

 

Dr. Z: There it is.

 

Dr. Sinha: You’re working mostly in the watermelon sugar zone. So, if you’re burning a lot of sugar, your brain’s gonna crave that sugar. If you’re working more in the mitochondrial zone, you are burning a great mix of a little bit of glucose and a lot of fat, your body fat in particular. So, that’s why when you do that workout, yeah, you’re not gonna come out that workout and feel like a million bucks. You’re not gonna get that adrenaline high. But what I’ve found is that mentally, I’m much more even, I don’t feel like eating the entire pantry. You’re much more focused. And you’re building mitochondrial fitness. And this gentleman that I actually interviewed, he’s actually one of the world’s greatest endurance athlete trainers. And he said, even for his top elite athletes, he always recommends that zone. And it’s not like they’re compromising performance. Because as your mitochondria gets stronger, guess what happens, Z? You’re gonna become faster and stronger at a heart rate of 130. So, if you watch sports, if you watch a soccer match or a basketball game, the fittest athletes at the end, they’re barely even breathing. They’re like on the mic and they’re speaking no problem. Other ones are hunched over. They’ve been… They’re probably an anaerobic body, right?

 

Dr. Z: Tripoding. Yeah.

 

Dr. Sinha: Right, they’re tripoding. Exactly. But that’s sort of… And it took me a long time to get used to that because I was a type A exerciser too. So, now when I go for runs, if my heart rate goes up, I’ll just switch to walking. I don’t need to run the whole three miles. I’ll mix run and walking. Beautiful thing.

 

Dr. Z: I feel so much better about myself because I tell you I’ve been craving that sort of exercise that’s slow and low, but I get into like 130-ish heart rate. And again, I don’t feel that rush of adrenaline but my mood is better. I eat less. All the things you said. How fascinating! Now-

 

Dr. Sinha: And by the way, can I click on one thing?

 

Dr. Z: Yeah.

 

Dr. Sinha: This is my women that were not losing weight pre-COVID. And I told them, “Listen, sorry, to say this to trainers, you need to fire your trainer because your trainers training you too hard. All you do is walk.” And they didn’t listen to me. And many even do, but some are like, “No, I need to burn more fat.” And I’m like that burn you feeling is not burning fat, that’s lactic acid.

 

Dr. Z: Yeah, lactic acid. Yeah.

 

Dr. Sinha: Yeah, you’re causing more inflammation. You can’t stick your diet. Your cortisol levels are going up. In women, cortisol causes more fat storage than men. The whole list. And now they’ve been forced into that. And I’ve had women shed fat even though they’re burning less calories. And it’s all because of what you said, the hormonal output of those lower intensity workouts is so much better. Now, I’m not banning that. So, if I go out for, let’s say a walk or hike or light jog, if I wanna do a sprint for like 30 seconds or a minute, I’ll basically walk really slowly til my heart rates are really low and then I’ll run like mad. and I’ll just get up to 140, 150 for maybe a minute max and then I come back. And then if you’re doing five or six days a week, if you’re feeling great, doing one day of mostly high intensity is probably not gonna wreck you. But most people aren’t doing that. It’s the opposite. They’re doing mostly the high intensity and very little of the low intensity fat burning mitochondrial workouts.

 

Dr. Z: So, useful. This is so useful. So, tell me how about weights? Where does strength training come into this?

 

Dr. Sinha: Strength training is really important. And I think the mistake I made in the beginning when I talked about these muscle parking lots is we gotta build stronger, bigger muscle parking lots. So, a lot of people kind of emphasized a lot of the weightlifting, but they gave up the cardio as a result of that. Now, it’s true that some strength training can build up cardio, but not necessarily. Because I’ve got some patients, they’ve been lifting really heavy. They look like this. If you ask them to run a mile, they could barely trot to half mile, right?

 

Dr. Z: Right.

 

Dr. Sinha: So, I think for me, strength is I wanna build adequate functional strength that lets me run faster, jump higher, and more functional, rather than limiting myself with really bulky strengths. So, a lot of sort of jumping strength, plyometrics, bodyweight type training. And that’s been a shift for me because before I was just trying to lift heavier and heavier weights, but I wasn’t doing enough of that. And during COVID-19 I’ve been teaching people to do that more often. Those are different types of muscle fibers that may not look thick and big, but they’re super functional. And they’re gonna help you age better. Because if you trip or you lose your footing, those fast twitches are gonna help you recover. So, that’s one thing, is more functional fitness and strength is really key.

 

Dr. Z: Bro.

 

Dr. Sinha: Yeah.

 

Dr. Z:  It sounds to me like you’re just making excuses, bro. Do you even lift, bro? Bro. Bro.

 

Dr. Sinha: Yeah, we are gonna piss off a lot of the bro signs people had there.

 

Dr. Z:  Well, we’ll have to go on that Brogan’s show. And dude, no, this is super helpful because this is attainable for people. This is also attainable for people.

 

Dr. Sinha: Both, right? The low heart rate and this.

 

Dr. Z: Both. Both. Because and again, I’m inspired because I’m like yeah. I was feeling a little bit like a war. So, I just hear my inner Hans and Franz. “Hey you little girly man. Your heart rate is not 170. Why are you not pushing? Pump you up. Pump up. Lift more. Lift faster. Lift, go. Go.” And then you’re like, “Why do I feel like crap? And why am I still fat? I don’t understand what’s going on.”

 

Dr. Sinha: Well, I’ll tell you my number one goal, and I teach it to people, is not to lift stronger is to recover as fast as possible. And I was motivated by this because my kids were juniors in high school. When I’d play basketball, we do an intense workout. No matter what we did, they have no soreness the next day. And I was like, “What the hell? Like what’s going on here?” So, then I started training myself to recover faster and it’s coming back to what I do during my workday. I’m doing hip openers. I’m doing hamstring stretches. Psoas stretches all this stuff. And now I’ve gotten myself, Z, where pretty much every day I can go out and do pretty moderately intense workout without having any soreness at all. I felt better than I’ve ever had before. But before, I was like, everyday, I’m like going and crushing it. Some like I felt like everyday, some muscle group is recovering. And it doesn’t have to be that way. So, if you work on faster recovery, you’re gonna feel so much better. And that’s also lower overall inflammation which means less injury, less cytokines, less all this stuff. And that’s really what we should be aiming for.

 

Dr. Z:  Less risk for COVID-19 complications.

 

Dr. Sinha: That’s right.

 

Dr. Z: Which is where it all started. Man, that’s dope. I like that. I want you to be my doctor. Actually, I need a damn doctor because since I left Vegas, I’m gonna have to have you do my serial LDLs and all this that I used to do just for fun, just to make myself neurotic. But what will eating this do to my LDL? And of course, as you know, LDL just fluctuating constantly.

 

Dr. Sinha: Right.

 

Dr. Z: It’s not like a one-time. Like it’s not a function of, “Hey, my LDL is 100.”

 

Dr. Sinha: Exactly.

 

Dr. Z:  No it was a 100 five minutes ago.

 

Dr. Sinha: That’s right. It’s a very dynamic picture. One way I think we talked about a bunch of various areas, but one way I wanna stitch all these concepts together is we talked about metabolic. We talk about musculoskeletal. We talked about mental health too, right? We’ve covered a lot here. One way you wanna think about this, and I don’t wanna get all woo on you, but think of these as energy systems. And many of us have trapped energy systems. Okay? So, when we talk about metabolic, we talked about how energy is stuck inside our cells. How do we unstick that? We basically improve our diet and we do more of the right type of physical activity. That’s gonna get our metabolism flowing again, right? Musculoskeletal, a lot of us are trapped in this position all day. We’re not moving. We get a lot of muscle tension. And muscle tension works in both directions. When your muscles are tense, your mind is more tense. You relax the muscles, the mind can free itself too. That’s the whole technique of PMR, progressive muscle relaxation, is if you can’t out-think your way out of stress, at least get the muscles relaxed. And then you can sort of think through it then. So, we’re talking about releasing the muscles too. And last we talked about mental health. And what is rumination? I tell people it’s emotional constipation, right? You’ve got thoughts that are trapped inside your head. But now we talked about writing them down, doing the third person reframing where you’re watching that crazy Netflix movie inside your head. That’s getting that energy moving along too. So, throughout your day, think about those three pillars. Some days my mind is in the right zone, but I know metabolically, I’m not doing the right things. I need to get moving more. Or my muscles have been fixing from the computer. Let me fix that in some way. If you can some way and some days just think about those three ends and try to get unstuck, you’re gonna feel much better. And those of us that are grappling with our thoughts, maybe you just need to focus on the muscles and the metabolism first. And then all of a sudden you’ll see a world of difference with how you process those emotions. So, a couple of closing thoughts there.

 

Dr. Z: Ron, I’m just gonna start calling you Brown Morpheus.

Dr. Z: That was awesome.

 

Dr. Sinha: God help me.

 

Dr. Z: That was awesome. That was exactly how we should think about it as a body, as a kind of flowing dynamic system. And you know that it can come off as woo-woo unless you look at it from a system standpoint, and go, you know but yeah, there is a flow of capacity. The body is a dynamic thing. The Japanese there’s a Japanese author, Haruki Murakami, who I’ve been a big fan of. And he has a book called “The Wind-Up Bird Chronicle.” And it’s about a 30-something-year-old dude who’s alienated. And he’s like his wife disappears and all this stuff happens to him. And it’s written in a magical realism style. So, there’s a little weird magic in it.

 

Dr. Sinha: Oh, I’m gonna check that out.

 

Dr. Z: Yeah, very cool. But he talks, he uses this analogy, which I think is big in Buddhist circles, especially in Japan of this blockage. Like this character was experiencing a blockage. And the way he opens it up, is he goes on this quest internally where he ends up, he’s in the bottom of a well and he’s reliving Manchuria. And all this crazy stuff’s happening. And suddenly he opens by the end of the book and the river starts flowing again.

 

Dr. Sinha: Oh, that sounds beautiful.

 

Dr. Z: It’s a really beautiful. And it makes you think of all the things you’re talking about. There’s a physical opening, an emotional opening, a spiritual opening. There’s a dynamic constellation that we are.

 

Dr. Sinha: It is. Do you know, as much as I used to maybe 10 or 12 years ago kinda criticized the woo-woo approach, the interesting thing is the woo-woo approach is way ahead of science. And it’s almost like you need science to, you need somebody with an MD PhD to call fasting autophagy for it to be accepted, right.

 

Dr. Z: So, it’s like, you need to relabel Peter, right?

 

Dr. Sinha: You need Peter Attia mitochondria. And I’m like these people are thousands of years ahead of us. So, maybe because I’m turning 50 next year. But I’m really starting to think I’m gonna stop like going crazy on the research of today and just follow my intuition and try to learn from these people that didn’t have internet, a podcast to listen from. They just knew based on their inner intuition. And as much as I like to track my data a lot too, sometimes you’ve just gotta unstrap that stuff and just rely on intuition. Because I think that’s something that’s eroding with all the technology we’re strapping to ourselves right now.

 

Dr. Z: Dude, I’m still with you. And that’s funny because I was such a fucking anti-woo pro scientist. Science. And I still am, but I’d say this, I’ve opened with age wisdom. Not so much wisdom, I’m an idiot. But this idea that introspection, looking at ancient wisdom and seeing how you can apply it is a huge font of wisdom. As long as we don’t start talking about antennas and 5G and nanoparticles, we’re good. Actually, this is helpful. That’s what I love about you, Ron, is you’re not, you don’t shy away from it, but you also don’t go full Dr. Oz on it, right? Because we need somebody who is the chosen Brown Morpheus.

 

Dr. Sinha: Oh, God.

 

Dr. Z:  Brown Morpheus. I’m off white Morpheus. So, dude, tell me about your podcast. How can people find it?

 

Dr. Sinha: So, I’m not podcasting yet, but I’m doing a lot of interviews on different platforms. But at some point I’ll probably launch my own podcast.

 

Dr. Z: You need one.

 

Dr. Sinha: But I need one. That’s what people have told me.

 

Dr. Z: Yeah, you need one. And I’ll help in any way I can.

 

Dr. Sinha: Yeah. But in that meantime, I’m doing a lot of writing because after these sorts of interviews I get so many questions around all types of topics. So, we’ll add a link and a page, but I’ve written a lot and updated COVID resource guide. These are all free resources or eBooks on sleep and fatigue, on cholesterol. Many of the principles we talked about, but people can just download this material and look at the approaches that I’ve used. And since we did the original COVID resource guide, we’ve upgraded, added some information on vitamin D, which is a separate topic altogether, but a lot of interesting things. So, we’ll include that with the show notes, the benefits.

 

Dr. Z: Outstanding. Can you talk about vitamin D in one minute or do you wanna come back and do a show on that?

 

Dr. Sinha: Let me see. Okay, let’s try one minute.

 

Dr. Z: Yeah.

 

Dr. Sinha: Okay? I’ll give you a very high level on supplements in general. So, with vitamin, let’s just focus on vitamin D. The way I look at vitamin D and supplements is number one, if there is a good mechanistic explanation for why vitamin D would work, that’s my first principle. So, we do know vitamin D has antiviral properties. We know it contained on the cytokine response, so it can be an immune modulator. So, that’s the first requirement I look at. The second thing is vitamin D does have a long track record of safety. I use it in many of my patients that are vitamin D deficient. And then the third thing is you look at the available studies. And there’s been a lot of interesting studies done since COVID-19. None have been full on scale, randomized control, large sample size, but there have been enough studies that we’ve looked at now, that show a fairly strong case for individuals that are repleted with vitamin D tend to get lesser infections. So, the risk of is probably two times greater if their vitamin D is deficient. When they do get infected, it looks like the complications in severity and the mortality tend to go up as well. So, there’s enough anecdotal stuff. Nothing that I’m jumping up and down about. But enough anecdotal stuff out there where I think it’s reasonable to take vitamin D as a supplemental strategy. And good old Dr. Fauci recommends it too. So, there’s a little bit of good validation there. But there we go. Thank you Dr. Fauci for being so open-minded.

 

Dr. Z: Take vitamin D PRN.

 

Dr. Sinha: Now, the confounders, there’s multiple confounders because we know obese individuals tend to have lower vitamin D because the fat acts as a vitamin D trap. Skin tone, African-Americans, Latinos, who are suffering a lot from COVID-19 mortality, they’re not gonna absorb as much vitamin D. They tend to have lower vitamin D levels. So, there’s confounding agents out there. And I don’t want people to think that vitamin D is a miracle pill, that if we give this to all high-risk populations, they’re not gonna die from COVID-19. I also worry about the overall message of these studies because some people think that, “Hey, I don’t need to improve my metabolic function and do all the things we talked about. I’ll pop a couple of pills and I’ll be good to go.” Heck no, I have not seen that pan out, but I think it’s interesting enough where it’s a reasonable supplement strategy

 

Dr. Z:  Essentially, I’m gonna take away this one-minute limit because now I’m really interested in this. And even though we’re gonna go a little over an hour, that’s okay. Because many people have talked about vitamin D. Many people have talked about supplementation. Vitamin D in my mind is very interesting because again, we do have quite a bit of deficiency. And again, the safety of repletion doesn’t seem to be unsafe to do it. The studies have been mas o menos. And correlation causation is always the struggle.

 

Dr. Sinha: That’s exactly right.

 

Dr. Z: But there is that, like you said, darker pigmented populations seem to do worse. They have lower vitamin D levels. I think that’s what the data was.

 

Dr. Sinha: Right.

 

Dr. Z: So, is there a downside? What type of vitamin D would you replete your patients with if they were deficient?

 

Dr. Sinha: Yeah. So, it would be vitamin D3. And typically the standard doses that they recommend are usually not sufficient for general population, especially if you have my skin tone or your skin tone in darker. For most individuals, even if they didn’t have easy access to getting levels checked, probably taking 2000 international units daily would be reasonable. But for individuals that have a significant history of deficiency, they’ve got darker skin, they might need more between 4,000 to 5,000. But talk to your doctors if you need to confirm. But I think it’s a reasonable strategy using vitamin D.

 

Dr. Z: Tell me about sun exposure.

 

Dr. Sinha: Yeah. So, sun exposure is another great way to get it, but now we’re hitting the winter season. So, I think that’s gonna be more and more limited. But for most people, if they wanna get adequate vitamin D exposure from sunlight, we call it burn time. So, whatever time it would take you for your skin to turn red and burn, you take half the burn time and you dose it two to three times a week. That’s what you would need. But you need it over your overall surfaces, right? It can’t just be in a long sleeve shirt and just through your face. It’s gotta be good exposure, short sleeve shirts, shorts. And these things are really not gonna be tenable in the upcoming winter months. So, I think getting sun exposure regardless whenever possible is good for us because it releases endorphins from our skin that make us feel better. It actually increases a release of again, nitric oxide, too. UVA rays actually elevate that. So, I think there’s a lot of good reasons for us to get more sun exposure, but it’s not gonna probably amp up vitamin D especially given the upcoming winter.

 

Dr. Z: How do you reconcile that with the thousands of dermatologists that are gonna message us angrily right now?

 

Dr. Sinha: I know they’re gonna message us angrily, but I’m gonna angrily retort back that the guidelines that are set by dermatologists unfortunately are not culturally stratified. So, I have patients of my skin tone and darker, that have single digit vitamin D levels. And there’s established amounts of research that showed that very low vitamin D levels are linked to solid tumors. So, as much as we’re worried about skin cancer risk, what about all those other risks are happening? I have not yet to date met a South Asian person that has had skin cancer, but I’ve seen plenty of them with solid tumors, insulin resistance, a lot of things that are connected to severe vitamin D deficiency. So, I think we have to take those standard guidelines. And I know those were well-meaning, but we have to tailor it to individual ethnic groups if we’re gonna do the right thing.

 

Dr. Z: How do you feel about sunscreen in general?

 

Dr. Sinha: So, sunscreen I think makes sense, again, to put it over your face because that’s not gonna be a major surface area where we’re gonna be absorbing a lot of harmful vitamin D rays. Or it’s not gonna be, I’m sorry, a vitamin D producing area necessarily. So, that’s fine.

 

Dr. Z: But should they wrinkle and you can-

 

Dr. Sinha: You’ll wrinkle. So, your vitamin Dis preventing the aging but then again, you gotta look at your skin type, your family history. For some individuals, they’ve got to use reasonable amounts but for someone like me, I’m gonna use some just to prevent from burning. But I’m not as concerned about that. I’m using it as more of a metabolic strategy and anti-solid cancer strategy based on some of the studies out there.

 

Dr. Z: Yeah. Interesting. This has been a change for me. So I used to sunscreen everything up. And again, it’s also an Indian cultural thing. Like my parents would yell at me if I get a tan. “You are getting so dark.”

 

Dr. Sinha: Yeah, you’re not to be dark.

 

Dr. Z: “You want to get darker.”

 

Dr. Sinha: Stock prices go down when you go dark. We’re gonna sell ya.

 

Dr. Z: Exactly. It’s true. Because Indians have a very interesting cast system about color.

 

Dr. Sinha: Yes.

 

Dr. Z: And so yeah. So, what I started doing though in later years is face, because I did get an actinic keratosis on my nose, because I grew up in the central Valley and then we moved to Vegas. It was a lot of sun exposure there. But having no hair, so now I use a light sunscreen everyday on the face and head, but arms and legs, I keep generally exposed.

 

Dr. Sinha: That’s right. That’s right.

 

Dr. Z: And I find I don’t burn. But you’re right, it feels good to be out in the sun. And I haven’t checked the vitamin D level lately, but since you’re gonna be my doctor now, right?

 

Dr. Sinha: Right.

 

Dr. Z:  You’re not even taking new patients. I’m like, “Yeah, well Ron, I’ll be showing up. I expect a rectal on the first visit because that’s how I say hi.”

 

Dr. Sinha: Oh God.

 

Dr. Z:  And yeah.

 

Dr. Sinha: Oh man, I’m gonna have to shut down the rest of my panel. You’re gonna be high maintenance. I can tell already.

 

Dr. Z: I am a super utilizer. I’m like the 10% that cost 100% of it.

 

Dr. Z:  Oh God help us. I know, He help us all. So, how about, so we talked about that, how about other supplements and things like that?

 

Dr. Sinha: Yeah, so I think the other ones that would fall in my category, vitamin C obvious has been around for a long time. We’ve known pre-COVID that taking vitamin C even 1000 milligrams per day can lower the risk of viral infections and actually lower the durations of those types of infections. Again, getting it through foods makes the most sense. So, with any of these supplements, we wanna really double click on food and get as much of that possible. It’s bioavailable. It’s the best way to get it. But I think vitamin C makes sense. Vitamin D makes sense. A lot of our patients are magnesium deficient significantly. So getting some magnesium supplementation is interesting too. Oh, one thing I didn’t mention, which is fascinating, is this whole metabolism thing that we talked about. When that mitochondria gets shut off, so one of the most interesting chemicals that’s an antioxidant in ourselves is actually melatonin. Believe it or not. So, we think about melatonin is just being generated from the pineal gland, but melatonin is actually produced inside the mitochondria. And it is actually a powerful antioxidant. And guess what? That whole mechanism that we talked about with that HIF molecule, when it shuts off the mitochondria, internal cellular melatonin production goes down and all of a sudden the risk of oxidation and toxic radicals goes up. So, that’s another one. So, they’re doing studies on melatonin.

 

Dr. Z:  With COVID.

 

Dr. Sinha: Yeah, yeah, for COVID actually.

 

Dr. Z: I saw that and I couldn’t figure out what the angle was because I didn’t dig into it. That’s interesting.

 

Dr. Sinha: Yeah, it’s that antioxidant, anti-inflammatory ability that it has.

 

Dr. Z: Again, it all ties into this web of what all this is. One thing I wanted to go back on, now that we’re gonna just go a little deeper is, if that’s okay with you.

 

Dr. Sinha: Yeah.

 

Dr. Z: We talked about hygiene hypothesis being exposed to natural filth. There are a lot of people who are anti-mask wearers who have said that we’re reducing our exposure to natural stuff and therefore we’re harming our immune system. How do you think about that?

 

Dr. Sinha: Well, we have to think about our current situation now versus sort of the larger picture of yeah, boosting our immune system health. Right now we’re in a situation where we have to keep ourselves and the people around us safe. And the masks are the best proven strategy for doing that. So, again, although there might be a little bit of science behind that hypothesis, I think in our current environment, it just goes out the window. We’ve seen the data around the world where masks clearly are having an impact on incidents, and in many cases, severity of COVID-19 outcomes. So we’ve gotta stick to mass for now until we see signs that shows otherwise.

 

Dr. Z:  Got it. Yeah. Yeah. Yeah. And I’m thinking if there’s any other stuff that people talk about. So, they always are talking about vitamin D, they’re talking about masks, they’re talking about other things. I think that’s really, I think we covered a lot.

 

Dr. Sinha: We did quite a bit.

 

Dr. Z: Yeah.

 

Dr. Sinha: Yeah, so one last thing I’ll finish with is, because a lot of my people will keep asking me how do we get nitric oxide up naturally. We talked about breathing. We talked about the nasal humming. Exercise is still the best way that you can elevate nitric oxide levels. And there are certain foods that can actually elevate it. So, one of them is this. So, interestingly, nitric oxide is a blood. So, there is red fruits. So, things like a watermelon can elevate it, dark deep colored berries. Beets are another important thing that can raise nitric oxide levels. So, now in the fall look for a lot of reds and orange type foods too. These can actually elevate our nitric oxide production. And also keep in mind that this is actually valid science that antibacterial mouthwash can actually limit our production of nitric oxide because it kills the bacteria that actually reduce nitrates. And I learned this from my good friend, Dr. Mark Burhenne, who’s an incredible dentist. He’s on askthedentist.com. And there’s multiple studies that show the antibacterial mouthwash limits our ability to produce nitric oxide.

 

Dr. Z: Interesting.

 

Dr. Sinha: So, all those popular mouth washes, wrap them, especially during this time.

 

Dr. Z: Once again, we’re thinking about that symbiotic relationship between us and those organisms that live with us. And not everything is pathologic. How’s your patient population holding up in general? How are you holding up in general?

 

Dr. Sinha: I’m doing okay. And interestingly, a lot of my patients as long… This is all about reframing. Like a lot of them, they felt suffocated in the beginning, but they found ways to adapt. They found coping mechanisms. And for many of them, I think they found extra time that they didn’t have in their schedule, including kids and teens. Like we’ve talked about the emotional impact on kids and teens. It’s been hard. But on the other hand, there have been a lot of teens that are actually thriving in this environment. I’ve heard about, for example, teenage girls that say that, “You know what? I don’t have the stress of thinking about what I have to wear to school and how people are judging me. I can just get up and go.” So, there are things. Obviously this is not a long-term healthy environment, but we gotta find the things that we can hold on to. What are the skills that our kids can learn that they weren’t able to learn in a traditional environment. Resilience is one of them, right?

 

Dr. Z: Yeah.

 

Dr. Sinha: You can talk about resilience all you want, but now they’re having to learn resilience in a real-life pandemic environment. So, I acknowledge all the challenges we’re facing, but I also don’t wanna catastrophize it so much that our kids are overflowing that this is traumatic. I’m not gonna get through this.

 

Dr. Z: We don’t wanna create fragility.

 

Dr. Sinha:  That’s right.

 

Dr. Z: We wanna create anti-fragility.

 

Dr. Sinha: That’s right.

 

Dr. Z: They get stronger from this and they’re growing from this. Yeah, I was just talking to my daughter about this. She’s 12 and almost going on 13 next month and a middle-schooler, seventh grade. And every day I comment, I’m like, “Wow, you’ve managed to dress down yet one more level.” Like basically a garbage bag and some pajamas and just turns on the Zoom and goes.

 

Dr. Sinha: What kinda hairstyle does she have going on? My boys look up the Beatles right now. Yeah.

 

Dr. Z: Oh, it’s Hermione from-

 

Dr. Sinha: Oh, yeah.

 

Dr. Z: Yeah, from “Harry Potter.” It’s just a big bush if like afro hair. And I told her, I go, “You must really enjoy not having to be in person in school.” And she’s like, “No, I would go to school like this every day now. Like this is who I am, dad. I’m this.” And I said, “Good for you, man.”

 

Dr. Sinha: Right. That’s right.

 

Dr. Z: And she’s not getting the pressure back from people making comments about why are you wearing a garbage bag to school? And it’s great. And that’s a great thing. What’s your take on schools in general? Do you think we’re doing our kids a disservice? What do you think is happening?

 

Dr. Sinha: It’s a delicate balance. But I think we’ve gotten to the point of everything around COVID-19 is a risk balance ratio, right?

 

Dr. Z: Right.

 

Dr. Sinha: So, I think we’ve gotten to the point where we have to be very strategic and we have to err on the side of opening the schools up if there’s adequate science to show that it’s safe enough, because now we’re really at a point where the longterm manifestations of this and the impact on kids, it can’t be good, right?

 

Dr. Z: Yeah.

 

Dr. Sinha: And in my own kids, even though they tend to be fine in this environment, I think there’s so many natural things that we took for granted. No matter how stressful of a situation we had at home, school was sort of a buffer insulation away from that. And a lot of kids unfortunately, experienced a lot of chronic stress in that home environment, whether it’s domestic issues or parents that are Type A that are hovering over them 24/7 now watching everything. So, I think we have to have a safe approach to this, but it makes a lot of sense for schools to gradually start opening up when they can, if they can.

 

Dr. Z: Yeah. And there is not a black and white thing.

 

Dr. Sinha:  It’s not black and white.

 

Dr. Z: People seem to think it’s a binary switch. It’s really not. It depends on the prevalence in the community too. It’s gonna be very hard to open up in a community where things are surging everywhere.

 

Dr. Sinha: Absolutely.

 

Dr. Z: And there’s a general level of fear that’s quite high, regardless of whatever the data shows on kids, and younger kids seem to be less problematic than the older ones. Colleges seem to be more of an incubation chamber. Which why are we surprised? I mean, I remember college, like, come on, dude. So, man, Ron, so we’ll put links to all your stuff.

 

Dr. Sinha: That’s good.

 

Dr. Z: People can learn more about everything you’re talking about from nasal humming, all the way up to-

 

Dr. Sinha: Watermelon sugar.

 

Dr. Z: Watermelon sugar.

 

Dr. Z: That’s right.

 

Dr. Z: That’s right. Perianal melatonin production or whatever you were talking about. And man, it’s a joy. It’s a joy to have someone actually in the studio. As always, that’s smart that we go back a long ways. And man, so let’s have you back when you’re ready. Whenever you have something new to teach us because you have a vast repository of wisdom, Brown Morpheus.

 

Dr. Sinha: Oh God, thank you.

 

Dr. Z: I know. It’s vaguely racist, but since we’re both brown, we can do it.

 

Dr. Sinha: Okay. It’s legit, right? So, thank you for this platform. It’s a great opportunity to really reach more people. So, thanks for the work you do during this time, especially.

 

Dr. Z: Oh, thank you brother. So, hey to the ZPac, check it out, share the video, leave a comment, hit like. If you’re on YouTube, subscribe, click the bell to get notifications and leave a comment because it helps juice us up and get this wisdom out to other people. If you wanna support our show and allow us to say all this stuff that we can say without me losing a job or losing a sponsor or losing ad revenue, become a supporter. It’s like $4.99 a month on Facebook or YouTube. You get a sort of super secret tribe of people where I may even play my guitar on the show, which is creepy and self-indulgent, but it really is a wonderful group of self-selecting people that get together and have a good time and learn from each other and are nice to each other, even though they have different political beliefs, which is unheard of these days on the internet. So, I love you guys and we are out. Thanks, Ron.

 

Dr. Sinha: Thank you. Take care.