Gained some belly inches sheltering in place? Not sleeping? Stressed?

Dr. Ron Sinha teaches us what puts us at risk for coronavirus complications and what we can do to can stay safer.

Check our prior shows with Ron.

Here are Dr. Sinha’s free COVID-19 resources as mentioned on the show. Follow him on Instagram.

All our COVID-19 videos are here.

– Hey ZPac welcome to the ZDoggMD Show, it’s Dr. Damania, ZdoggMD if you’re nasty. All right today one of my favorite people he’s been a two time guest on the show. Dr. Ron Sinha, he is a internal medicine doctor at Palo Alto Medical Foundation, my old haunting grant stomping grounds haunting grounds because now I’m a ghost. Here in Palo Alto in the Bay Area, Silicon Valley, he has made a worldwide reputation for being able to help treat patients with things like metabolic syndrome insulin resistance, it particularly in certain cultural groups like south Asians, but he’s even more known now for working in corporate areas, teaching people who particularly work from home that may have sedentary lives, how to be more healthy and avoid things like diabetes, heart disease, polycystic ovary syndrome. And I will definitely link to his other interviews he’s done with us before they were really really, really educational. But today, we’re gonna talk about something that is I don’t know on everyone’s mind. Which is COVID-19. And how first of all, we can understand what may put us at risk as patients for actually getting very sick from COVID. And how that relates to everything Ron’s been talking about and then more importantly, what we can actually do to actually get in shape so that we’re less at risk. Were we to actually come down with the infection. Ron, welcome back to the show, man.

– Hey, great to be here, man. It’s fun third time’s to charm.

– Hey, did I get any of that intro wrong? ‘Cause I just make that stuff up as I go.

– You nailed it, man, you’re amazing.

– No formal training. Hey, so how have you been doing? You look great, by the way. So Covid’s been good to you clearly.

– Yeah, absolutely, like my pigmentation I’m getting a tan off, everything’s feeling good right now. But you know, I think we talked about this before the show. I think we’re busy as heck right now, which is a good thing because we wanna get a message out to our people. Obviously the pandemics not a good thing, but I think it’s making a lot of us rethink our health personally on a population level and what things we need to do. So all of a sudden, a lot of my patients or clients that keep postponing health to later like I won’t get a heart attack till 10 years later. Now all of a sudden, it’s on their mind cause something can happen within days, weeks or months. So that’s not the kind of alarm flag I wanted to happen for my patients but we should really take advantage of this opportunity to see what we need to prioritize around pandemic.

– That’s so important because like it’s true. These sort of chronic diseases, diabetes, obesity, heart disease, hypertension, this sort of stuff. It’s silent, like, nobody thinks about it, right? But now everyone’s like, hey, guess what, that stuff is a risk factor. All the epidemiology we’re seeing, if you have that you are more likely to do very poorly with COVID-19. And I think we’re gonna get into a little bit about why that might be based based on pathophysiology, but it’s never been more important. You know, I’m not gonna lie to you. So over the last few weeks being at home, I have sort of any others the stress of like, all this stuff, right so I’ve been comfort eating a little bit I’ve been eating ice cream which I never do. I go to Lunardis which is our local grocery store and they have this ice cream Lunardis brand new ice cream which is really treat ice cream from San Jose, it’s little shop, it’s so damn good dude. But it’s like a dopamine surge every time I have a bite, so my midsection has gotten a little chubbier even as I’ve grown more muscle mass because it’s like being in prison like I’m lifting weights, but I’m pretty clearly metabolically less healthy than I was and so now if I get infected along with my clotting disorders, factor five leiden and pro thrombin two to one a I’m gonna die like a dog. So let’s start to just dig in. Now that I’ve put my own medical history out there and violated my own HIPAA. Let’s dig into this because I think there are a lot of people who are watching are gonna be like, dude that’s me in to some degree and what can I do to stay safe?

– Absolutely, so I think my purpose really for this interview is number one, we got to empower people with knowledge and not breed paranoia. ‘Cause some of the things I might talk about might make us think that, oh my God, I’m gonna die, you know, because of this. But hopefully we can provide some tools during this interview that we’re gonna give you some strategies that I’ve used personally in myself, and also with my patients too. But I think at a high level, what you brought up is so key, I think we need to start looking at COVID-19 less is an infectious disease, which it clearly and obviously is, and really looking at it as more of a lifestyle disease like anything else. So if we already put that lens over it, we can start doing the right things. And a lot of the research on doing Z has been focused on lifestyle is such a general broad term, right? There’s a million different things we can do. But I’ve been digging deep into the science. So what can we specifically do that will have the most impact on protecting us from COVID-19. And guess what the icing on the cake is anything you do to protect yourself against COVID-19 once for over this pandemic nightmare. It’s gonna help you live longer, it’s gonna lower your risk of heart disease, diabetes, cancer, all the crap that we’ve been talking about in the past. So I thought one thing is I’m a kind of a visual learner and a visual teacher, and for those of you that might be watching this on YouTube, some might be listening through a podcast at some point and happy, check out the YouTube because I’m gonna put up a couple of slides that have been game changing in my talks to big Silicon Valley companies. So if you don’t mind, I’m gonna kind of be a little bit of a teacher and put some slides up if that’s cool with you.

– I love that idea, and I actually wanna also mention that since you’re talking to these big Silicon Valley companies, why is that relevant? It’s relevant because they have a high proportion of people with early metabolic syndrome, people who are not exercising in a way that actually helps their insulin resistance, that eat like crap, that are sedentary and that are now at home. And so this is a perfect petri dish for disaster and you’re there to try to help.

– Very well summarized Absolutely. So you know, I know your audience is pretty savvy about this stuff, but the first thing I like to do is I wanna sort of step back and show you guys what’s happening with COVID-19 ’cause one of the greatest threats to our immune system is fear of the unknown. You know, it’s funny ’cause when I get stressed toxin sometimes I have to come up with analogies. Like when Look at your email in basket, pretend it’s a tiger chasing after you, but right now that analogy, actually, I would rather be chased by a tiger ’cause I can see what’s coming after me and either get eaten or I can hide, but now all of a sudden my analogies are actually mute at this point because we’re in the face of an unknown predator, which we can’t see. And that can be an amazing trigger to our immune system. So one key thing I tell people is we have to empower ourselves with knowledge, which you’re doing an incredible job of, because if we can turn on that logical brain, while we think about the situation, we’re gonna tame the impact on our immune system. So that’s my effort here with this diagram. So here, we basically got COVID-19. And what’s happening and hold on one second, let me just make sure the technical, so when COVID-19 basically enters our lung cells, it enters using the ACE two receptor. It’s got an instruction manual, which is the RNA gene. So it’s got a copy of the instruction manual, but it doesn’t have the 3D printer to make copies of itself, right. So it goes inside our cells and in this example, I’m talking about the lung cell and it hijacks our 3D printer. So once it’s inside, it basically starts making copies of itself, and so that’s the viral replication process that happens inside our cells. So that whole process I kind of referred to as being the viral load the external factor. Now, as a result of that viral replication, what happens internally in our body is we start to launch an immune system attack. And there’s a specific molecule that I want you to keep in mind, cause I think the more we can put some terms around this, the less you know, sort of unknown and fearful we’re gonna be. So there’s one sensor inside the cell, and it’s called NLRP3, okay? And NLRP3 is like an alarm sensor inside our cells. And it specifically reacts when COVID-19 hits the surface of a receptor, that ACE2 receptor. And what NLRP3 does is when that alarm signal is set off, it recruits messengers called cytokines, these tiny protein molecules that come and they try to defend us. But the problem and I think you’ve talked eloquently about this before guests is if we have an overload of that cytokine coming in, we call it a cytokine storm, I actually refer to it as a cytokine fire. Because when that fire gets out of hand, as I’m showing this diagram, we actually initiate a process called pyroptosis, now pyroptosis is an interesting term, you might have heard of a term called apoptosis, no, I’m sorry, apoptosis, which is cellular program death. But pyroptosis is actually specific term, that when you have an infection, like a virus attached to your cell, it triggers inflammatory cell death. So literally, you are starting a fire which will cause the cell to explode and die. And then all the fluid and inflammatory factors are what leads to a lot of the complications that we see. So when you look at this, again, you’re thinking about viral load external, and then you’re thinking about cytokine load internal, and that’s why summarize this in my sort of diagram here. For the last several months, we’ve been focused on viral load the external factors, social distancing, hand hygiene, mask, you know, fomites, whatever and that’s important to do, but what I’m telling people is if we over obsess and exclusively focus on the external, we’re gonna create a lot of internal stress, we got to shift to the right side of the diagram. And think about some of the factors we’ll talk about today, the internal cytokine load, the stress, the sleep, the nutrition, the activity, the underlying conditions, the visceral fat, which we’ll dig down in a moment but that’s kind of my high level aerial view, sort of what’s happening in this system so.

– That’s really helpful from a visual standpoint. And what’s interesting here is you start to immediately jump to what seems to now become obvious looking at this, which is yeah, okay, you’ve got these two components, viral load, which is gonna be important, but the cytokine load is what’s gonna put you at risk for that catastrophic sequence of events that ultimately leads to the inflammatory cascade that leads to the complications that you see whether it’s all the gue, for lack of a better medical term in the lungs that prevents oxygenation, or whether it’s the blood pressure and multi organ system failure, or the myocardial damage, the heart damage, the kidney damage, those kind of things that result from the cytokine load. Now, one thing I wanted to ask you, because there’s some theories, right that cytokine storm, part of the reason that young kids don’t necessarily get so sick from this is that they have enough of immune system that they can kind of suppress viral load a little bit, but they don’t have a robust enough immune system to launch a cytokine storm is that something you’ve heard as well?

– Yeah and that’s a common question I get and right now is, you know, there’s nothing definitive around this, but I think that intuitively makes a lot of sense based on this. They’ve got that cytokine dial is right it’s like a thermostat you want it at the right level. But exactly the right time later on when our cytokine storm is getting more activated, and some of this is genetic and developmental, but a lot of it i think is emotional too ’cause I know back I was, you know, a certain age, I was in internalizing stress, about work, about marriage, about my mortgage, and all these things. So I think we have more cytokine inflaming factors there. But also you’re right, our immune system is a little bit different than younger kids. So I think that the remix a lot of sense.

– Awesome and everything on that cytokine load column is stuff that can actually affect your cytokines so stress sleep, nutrition, activity, those effects cytokine load?

– Yeah big time, yeah, I’m gonna show you some mechanisms but I think to me, that’s a hopeful message like up till now you might be sort of scared of what we’re talking about, but all of the things on the right side are things that we can influence impact. And believe me, the cytokine connection has been there for decades. There’s multiple studies that show the impact of sleep and stress, activity body composition on cytokines. And you know, again, when you take that fire analogy, Zeb, I tell people that our cells, you know, the environment that COVID encounters, if we’re thinking about fire, we don’t want there to be flickering flames in dry kindling inside our sell before COVID-19 even attaches, because if we have a very flammable environment, that’s gonna make us much more susceptible to having that cytokine firestorm. So you know, many of us for many years have been initiating negative sort of lifestyle habits that are on the right side of this graph, and then all of a sudden, if you introduce a virus like COVID-19 into it, we can cause a lot of baseline excess inflammation. So I wanna dampen those flames because really honestly is you know, is we re-enter back into society. You know, I tell people, you know, I’m gonna be out in the front lines at some point, I’m doing most of my tele video visits, but I’ve accepted the fact that there’s a really strong chance that I’ve been exposed or I will be exposed to COVID-19 at some point over the next several months. So now the game is gonna be how do I keep my cytokine and that flame under control? You know, so I think that’s the way we sort of wanna think about this.

– I like that analogy because it reminds me of the California wildfire analogy. If you have a bunch of dense vegetative overgrowth and then you get a spark, you’re gonna burn really fast. And this is why because part of the reason people are stressed Ron I think is that they feel no sense of control, and they feel like okay, this is this horrible enemy that I can’t fight. But the truth is, there are things that we can do that will help give us a sense of control lower our stress levels, which will help, it’s a virtuous cycle, right?

– Yeah, absolutely, that’s a great way to put it yep agreed. So should we launch into some of these strategies? What do you think?

– Yeah show me? Are you gonna show slides or you want me to look at you?

– You know what, I’m gonna show you a couple more, and then we’ll go one on one all right? So a few quick things I wanted to highlight for you this Covesity mechanism. So I call this term Covesity, and basically, it’s a connection between that visceral fat and how that puts us at risk. So again, now that you’re familiar with this diagram, I wanted you guys to sort of check out this diagram of this guy here with the visceral fat. And what I wanna make clear is inside his belly, he’s got these chemicals that are highlighted, which are cytokines like IL six, TNF alpha. These are pro-inflammatory cytokines. So when we’re carrying extra belly fat, we’re already fueling that flame that we talked about you eloquently call it the dry kindling of the fire storm. Really that’s what we’re doing. The other chemical here also is angiotensin two. And angiotensin two, as you probably know, that is a specific molecule, it’s not a cytokine. But it is have been intimately linked to COVID-19 risk. In fact, they’re finding that individuals with elevated serum levels of angiotensin two have more acute lung injury. It’s also associated with myocardial remodeling. It’s a powerful vasoconstriction. So all these factors are these chemicals can come out of our belly fat, and contribute to that firestorm. So just wanted to make that point really clear in this how important is connection between visceral fat, and that cytokine load really is.

– And it’s so interesting, because angiotensin two is what binds to ACE two receptors, correct?

– That’s exactly right.

– So this is part of the same cascade, they’re all intimately related, and what’s interesting is visceral adipose tissue, so just a little bit of belly fat can increase the levels of these things that are then affiliated by association with this process.

– Exactly, exactly you got it. I’m gonna show one last slide and we can get back to face to face here. But this one was really interesting to me because I got to say that the studies that are out there on emotional stress and emotional suppression and cytokine surges it’s pretty compelling. And this is one study that really resonated with me because if emotional suppression was an olympic sport, I would be a gold medalist growing up muscle suppressor, a lot of my life, like a lot of guys and people from our cultural background. But I wanted to show you this study, which I thought was just mind blowing, and I’ve shown this on a lot of my Silicon Valley talks. And what they literally did was he took a group of subjects and they emotionally rated them on a scale is either being cognitive reappraisal is and what cognitive reappraisal means is, you literally say that I’ve control my emotions by changing the way I think about the situation I’m in. So that’s the reframing, or you rate them as being expressive suppressors are emotional suppressors, where they say I keep my emotions to myself which is pretty much the DNA that I’ve sort of been brought up in. And then what they did is after they raided their emotional patterns, they actually sprayed some cold virus on them it wasn’t Coronavirus, but Rhino virus, and then they measured their nasal cytokine levels to see how much cytokine was released locally, and often nasal cytokine level can be a surrogate marker for what’s happening deeper down inside our cells. And what they found remarkably was cognitive reappraisal consistently had lower nasal cytokine levels, especially IL six. So that to me was mind blowing. It just shows you are emotional, those subtle thought patterns can have a huge impact on immunity.

– You know, none of that surprises me in the slightest Ron because it just people and it’s true with like, if you get cancer, your likelihood of surviving actually seems that the people who reframe for the positive and seem to see things through a positive lens tend to do better. You know people live longer when they switch the hospice from say acute chemotherapy sometimes because there’s suddenly this opening in this release of the contraction and stress state and the cortisol and all that stuff. And I wonder whether it’s just cytokines or whether it’s a broader thing. But even just anecdotally, I’ve noticed when I meditate regularly, I get less sick, I get less viruses. Now, this is all anecdote. But just from a personal experience it there’s something there to reframing and to stress reduction that I think is real?

– Yeah, I totally agree I think both of us know anecdotally from dealing with patients that’s there. But as you know, a lot of us that are kind of left brainers we need sort of that scientific linkage. So I think this is an opportunity for us to really educate people, there is a molecule out there that’s being directly impacted. And now in today’s world, that molecule is linked to this pandemic virus and a matter of actually control our health outcomes from that. So I hope as a result of this, that it’s gonna highlight everything you said, because you’re right. It’s remarkable how we approach things with our mind how that can have an impact on immune system and disease onset and survival so it’s really critical.

– It makes me wonder too, and this is speculation, we see such a high prevalence within healthcare professionals of serious disease. So they get it, but then they actually get quite sick. And there was speculation that you know, they’re getting a high inoculum or, but I wonder too whether those health care professionals that live with a constant burning fire of stress and immune suppression and that sort of thing, and now it’s magnified by the lack of PPE, by the feeling that you’re gonna bring it home to your family, there’s a recent story about Lorna Breen who took her own life, emergency physician in New York this is an epidemic of this and it affects healthcare professionals even more, but you’re curious if a lot of your patients are actually healthcare professionals that you see.

– I have a fair number of those and you nailed it because number one, again, coming back to my framework, they were exposed to a huge viral external load. And on top of that, because of training and what they’re exposed to, I mean, the worst thing is for an emotional suppressor to go through medical training where you’re told not to share your vulnerability like you’re on surgical rounds, or whatever and you keep all your emotion and pain inside, right. And many of us first actually, it’s an adaptive function. When we’re on the wards and things. We learned to do that as a protective mechanism. But if we don’t have adequate releases after those long shifts, or during our breaks, and many of my patients are healthcare workers, they spend all their time thinking and breathing this at work. And then they’re on their phone when they come home and the news, you know, you pick up your phone and every news headline story is related to this. Their brain is getting no break from this at all. So I’ve actually had to implement I call this media distancing, I’ve had to implement significant media distancing work, I have like a fixed amount of time, maybe a half hour or 60 minutes, I only checked two or three news sources. I checked those out, and then I’m done with it ’cause I don’t wanna hear anything related to COVID at that point, I’ll just focus on my other stuff and I think a lot of us healthcare workers need that even more than anyone ’cause we’re living and breathing in my email work in basket, the number of COVID-19 updates I have through the internet are already overwhelming. So I need to do more on top of that.

– You could be up picking boxes men. Well, I think it’s important. I spoke with Jud Brewer who is a psychiatrist on the show, and we talked about the social contagion. So someone may not sneeze on you, but through media and social media, your brain can be sneezed on from anywhere in the world, and that triggers its own set of responses, so this is actually I like that idea of media distancing I wish I was better at it, because now I feel like well, it’s part of my job to scour the media and then parse it for my audience. But man, it’s taking a toll on me dude, I’ll tell you like ’cause this is again this is an aside. There are people who sometimes comment Z like it seems like sometimes you’re changing your emphasis on what you’re talking about from show to show to show to show why is that and then I look at it and I go well, because I’m surrounded by data inputs that are contradictory constantly, and you’re trying to figure it out. Imagine what somebody who has no medical education, feeling like, right, it’s a tremendous stress.

– It’s key, but you know, I think you bring up a key point. So even if you can’t detach yourself from the media, I think in your case, you’re flooded because of the work you do. But even this subtle shift of how do you emotionally distance yourself while you’re reading that news? So if you’re doing research on it, if you take more of that cognitive logical approach, that you know what I’m putting together a program that’s gonna help educate and empower and energize healthcare workers that are burning out on this, if you have a sense of mission and purpose around that, I think it’s different. My wife, who’s a pediatrician, she spends a lot of time looking at news stories, and in the beginning I was like, Saeron, you’ve got to calm this down. But I realized that for her, there’s an element of intellectual stimulation. She loves public health, this is an interesting problem to be solved she obviously is emotionally affected by it, but she’s looking at a little bit more than Einstein logical brain, but you mentioned you said it right for people that are not educated along that they think this is just utter cast the skies falling, basically. So it’s our job to provide a little bit of perspective and logic around that so we can take the edges off the emotion. But again, I think even if you’re inundated with this media, having the right framework of looking at this is really key. You know, one thing that I think stressed out a lot of my patients is those heat maps, right? When you see those red circles expanding, people literally think that there’s virus everywhere, you know, they don’t realize that this is a density of the virus in certain areas. But people think that if I step outside my house and I’ve done about a dozen tella video visits, and I have individuals, patients who are not even stepping outside into their backyard, because they think the virus is floating everywhere. So those are the types of stigma we have to avoid.

– Have you noticed because this is something that I pay careful attention to, after reading a lot of Jonathan Heights work about cognitive distortions. So you know, in cognitive behavioral therapy, you’re taught to recognize disorders, sorry, distortions of thinking. So, depression to some degree as a disease of distorted thinking. We ruminate on these different ideas that are not accurate when you shine a light on them. There may be a kernel of truth but the ultimate truth is no, that’s actually not what’s true. And that rumination makes it very hard. Now when we look at COVID, and people’s mental response to it, you see a lot of these distortions and you see it on Twitter a lot I saw it this morning. Catastrophizing, oh my God, we are never gonna get out of this, we’re all gonna die or our economy is completely destroyed. We’re never gonna recover from this, that’s catastrophizing or overgeneralizing. Oh, well look, because you know, this is happening in New York, well this is gonna happen in my town or, you know, a failure to see the positive is another thing like look at actually what’s gone right, we’ve actually bent the curve quite a bit. We’ve avoided having our healthcare system get overwhelmed in many levels, you know, so I think it’s important to recognize those distorted thinking patterns because if you can apply an antidote, it can actually lower stress.

– You know, you bring such a key point I love this because just what you did the process you went through of labeling your cognitive patterns, that alone takes the edge off it. So if you know there’s patterns of magnification, extreme language use, you know, sometimes I’m doing that too my wife and I talk when we’re talking about our president and all this stuff and then sometimes I tell myself okay, there I go with extreme thinking or there I go with magnification. So there’s a really interesting study that was done, where at UCLA, they did functional MRI scans with people with these emotional thought patterns. And they found that the simple process of labeling your thoughts with one or two words, tame down the emotional brain engaged, the logical so if you’re getting into the pattern, so sometimes I’m like oh, there I go, thinking about being on a ventilator again, you know, even if I wrote down fear of ventilator, you know, on a piece of paper, and I wrote that down, and just tore that up, just that process can really take the edge of that and you mentioned rumination, that’s when we’re stuck in our head and those movies over and over, but just a thought process and for me, the great thing has been, you know, I go out with a hike with a friend of mine socially distance apart and often worth kind of throwing those thought patterns off each other, you know. And so I think having those extra outlets, and this is where our colleagues in the healthcare environment, wherever if we can get some of that objectivity that could really help us deal with these patterns.

– I love that, I love that, naming it is actually a way to heal it in the sense and I like to think of it from a kind of a meditative perspective, it’s like you have a thought arise or impulse and that’s beyond your freewill. You don’t choose what you think you choose your response to the thoughts. So now you have a space where you go okay, I can either get lost in this and identify with it, or I can say oh, look at that. That is, you know, I can label that’s noting, right? Oh, that’s what that is and it really does change the book “Feeling Good” which was the cognitive behavioral sort of breakthrough book by that Stanford guy. Back in 1980, they did a study where people who just read the book actually had improvements in their depression scores, just purely from reading the book. And I think it was just purely from that same thing naming the distort, all my thinking is very distorted. And so maybe that’s why I’m so unhappy all the time so.

– Totally.

– Yeah, yeah.

– Yeah I was gonna ask you questions. Do you there’s one thing I’ve always meant to do, but I’m not very regular, and that’s actually keeping a journal, do you do any journaling? I mean I know you spend so much time but I’m just curious if you do any of that.

– I’ve done it historically, I haven’t done it recently. It’s so helpful, you know, when people and again, this is, again, a slight tangent, but people who have, you know, psychedelics have been studied much more now for mental illness and things like that. The people who do the integration process afterwards, the journaling of the meaning they’re getting out of their experience, have long lasting benefits, as opposed to someone who does like LSD recreationally or mushrooms recreationally, they’re going to have a good time. They don’t get that lasting benefit. I think there’s something to the the writing things down and integrating it that’s very important.

– Agreed, and I’ve been telling people I have not been disciplined about that I feel like I’m doing so many other things in a disciplined way that has not been on my bandwidth. But during this time, every few days, I’m actually journaling, I’m calling it my pandemic journal, because imagine if we were going through this right now. And we had a grandparent from the 1918 epidemic that actually shared some accounts of what they lived through. And you know, through that frenzy, I’m sort of thinking like, what is a legacy I wanna leave for my future project, you know, whatever 50, 60 years. Do I want them to know that I’m baking muffins every day? I’m getting 20 pounds and I’m depressed hiding under a blanket? Or is it that I wanna share some vulnerability? You know, definitely, this is a tough time for us but we as a family have come together and this is what we’re doing to get through it. And I think it kind of maybe energizes us to know that what we’re doing now we can really send a message to our future generations that when they go through their God forbid pandemic or whatever war, whatever comes up, you know, our ancestors were able to sort of rally and get through this. So it might be a way to sort of think about this.

– I love that you know what it is, it’s like a Heisenberg uncertainty principle for life. You go, okay, if I measure it, if I write it down, it might actually change what I actually make happen. And that’s very true because you can experience like you said, the weight gain and all that or you can be like, well, now I’m writing this down, my kids are gonna see this. I have to be living my life a little bit differently now so speaking of that ’cause this is a great discussion but I wanna bring it back to what your thesis here which is this inflammatory response that can be so harmful. I think a lot of people wonder, what is it that separates people who might get very sick in COVID from people who aren’t and what can I actually do about it? So getting back to your fire analogy and all that, how do we think about that in terms of like people who are at risk in terms of diabetes or insulin resistance, what’s up with hypertension? Why is that a risk factor?

– Yeah, I mean, it’s a good point with hypertension, we’re not quite sure but okay, so a couple of things. Number one, it does sometimes reflect the fact that angiotensin two is very active, and we talked about the fact that angiotensin is linked to miocardio and lung injury. The second thing too is we are finding now and this is even before COVID-19 we’re now finding that hypertension is a predominantly inflammatory condition. And if you look at the specific pathways guess which pathway is specific for hypertension, inflammation, it’s that same NLRP3. So there’s an overlap between that as well too. So I think all of this is sort of aligned. But yeah, let’s get kind of tactical about this because I’m finding that a lot of my patients like you said their lifestyles now in sheltering or making things worse, but on the other hand, I have patients that are actually doing better because now they’re not spending two hours on the road, they’re not in a lot of unnecessary meetings. So first thing I’m telling people is all that time you spend doing unnecessary commuting and other time, let’s devote some of that into activity. So your morning commute now is going outside for 20 to 30 minute walk. And for anybody who had has issues with weight or insulin resistance, morning physical activity is absolutely essential before in the old days I still tell people fit exercise in wherever you can. But if you wanna lower sugar, body fat and lower inflammation, if you have 60 minutes in the day to devote to exercise, you wanna distribute that activity evenly throughout the day. And I’m gonna tell you why. Because multiple studies show that when you do sit for more than 45 minutes to an hour at a time, elevated cytokine release actually happens. So you wanna be a very fidgety worker I mean before we talked about this, you mentioned that you have a lot of gym equipment in your office, and I’m down here right now and today I’ve got like a kettlebell down here I’ve got, let me see I’ve got my exercise ball everyday I’ve got different sorts of contractions. And the beauty is sometimes I’m in a meeting and nobody knows, you know, I’m not always visible on the meeting. So I can be doing some of these exercises. So stretching my hamstrings, but the whole thing is if you can distribute patterns of physical activity throughout the day, it’s gonna be metabolically healthier for you it’s gonna lower insulin resistance and it’s gonna keep that cytokine storm much lower too.

– So bro I mean, I’m not saying that this phone is a weight but it’s pretty much all I do all day, now that you know and then I actually to put another point on that run. You know weigh the way you cognitively frame this is you are training for the COVID marathon. Like this is the thing bending the curve means eventually people may get infected it’s just giving you time. We bought you some time, train for the damn COVID marathon, get in shape, lower your cytokine kindling and in shape you’re gonna talk more about that. And some of that you said is just spreading out exercise over the day not being sedentary sitting. Sitting all day is gonna raise your cytokines. What else would you think about that?

– Okay, so there’s three things I want you to think about. And this is really key because we have to do each of these. So I call this my ABCs okay? So the a is activity so get regularly distributed activity, and we talked about. The b part is breathing and most of us are not good breathers. So while we’re looking at media, while we’re at work and stuff, even while you’re sitting at rest, most of us breathe in our upper chest zone, we don’t really send air to our diaphragm. And this is key because what people don’t realize is our lungs are gigantic oxygen tanks that extend from our collarbones down to the top of her abdomen. But most of us are only using a very small part of that oxygen tank. And if you see this, you know the reports of people and what they feel like when they get a severe COVID-19 infection, they feel like somebody put a bag over the head or they got dragged underwater or they got dropped at the top of Everest and we’re told to run a marathon, there is a significant air hunger that they can feel there’s others that don’t feel that, but we know your ability to oxygen is compromised. So even while you’re sitting and working, and you’re sedentary, you need to start engaging in diaphragmatic breathing practices. And this is something I really highlight my recent posts, because if we can engage that diaphragm, even at rest, you’re gonna get a lot more air into those lungs. So really key to make sure you do that.

– What a great tip nobody talks about like because, you know, we had Scott Weingart on the show talking about he’s an ER doc and talking about how his patients who are the happy hypoximic, the ones who have very low blood oxygen levels, but they’re actually comfortable. They’re able to sustain a rapid respiratory rate so they can oxygenate without tiring so their intercostal muscles their diaphragm all their sort of accessory muscles are kind of ripped. And so they’re able to be like and just pant and do okay without needing a mechanical ventilator because they’ve tired out. So that’s another aspect of training for that COVID marathon it sounds like.

– Yeah, and I gotta explain one thing you and I call this sort of hypoxia resilience. So a lot of us are able to tolerate short periods without air and we do okay. Others have a very suffocating response to that. And just think about stress to our body. When we talk about our immune system responding. We can go what, three weeks without food, maybe we can go three to four days without water. We can’t go more than three minutes without breathing. So the minute we feel air hunger, our immune system is on fire. And I got to tell you, despite me doing a lot of exercise, I’m somebody who naturally didn’t do a very good job of tolerating brief periods of air hunger. I’m not a good big fan of swimming. When they do that annoying and 95 fitting. I hated that thing, right? They put that thing over you some of us intrinsically are not good at tolerating periods of air hunger. And you can actually train out of that if you start using your diaphragm when you breathe in exercise. If you do some simple breathing techniques, you can actually remove that stress and again, coming back to visceral fat, when we’re in a hypoxic situation, the inflammation in cytokine storm comes from multiple directions. But studies have shown that one of the doors that gets unlocked under hypoxia is your visceral fat. So hypoxia can cause the visceral fat gates to open and flood open cytokines. So as we get more aerobically finzi, we’re actually gonna increase that threshold. So if you get barely out of breath, going up a flight of stairs or walking around the block, we got to get that game better. We got to get you walking a little bit faster and improve endurance like you said, we got to train for this like a marathon, we’re not gonna have that massive air hunger and cytokine release from this and there’s very simple ways that we can do that.

– I love it because it actually gives people something they can do instead of cowering in fear with cognitive distortion all day, you can actually go yeah, here we go, and then you can journal about how well it’s going you know, one thing, I have a question for you, this is interesting and I just keep popped in my head. So you hear about this there was an Ironman triathlete or something you got very sick with COVID I think ended up on a ventilator this is maybe it’s an apocryphal story, but I heard the story. Could it be that because and you’ve talked about this in your previous book by the way everyone should know everybody should know that Ron has a website what is it South Asian cultural solutions?

– Yeah, yeah, you can put in I’ll flash up the URL at the end, so no problem.

– Yeah and perfect and we’ll put it in the links to the description everything, so Ron has free resources, a free ebook and some other things that will give you some of this so don’t panic if you’re trying to write down all the suggestions he’s got these online. But the idea that over exercising particularly aerobic exercise can lead to a immune deficient inflammatory state is something that we may wanna just touch on real quick yeah?

– I love it, yeah, ’cause I think again, we have people in different ends of the spectrum some, we can’t pull them out of the chair. So we got to get in getting some movement. And then we’ve got types As that are over exercisers, and under more stress, they exercise even more. And there is an ideal dose to exercise. So for doing a lot of high intensity anaerobic where you’re huffing and puffing through mouth for extended periods of time, that could compromise and weaken the immune system. So typically, for myself and other patients, I recommend if you wanna do more of an anaerobic type of workout, if you’re in shape for that, maybe do that not more than once a week, but really, for baseline immune system function for longevity, you really wanna be in that aerobic zone. And a very simple rule of thumb I used to quantify this, if you do check heart rate 180 minus your age is a great rule of thumb. There’s a gentleman named Phil Methadone, he trains only athletes and uses 180 minus your age. So if you’re 40 years old, your ceiling is gonna be 140. You keep your heart rate about 120, 130 not above 140. It’s an awesome kind of tool to sort of do if you’re not tracking heart rate. Then go by nasal breathing, so how fast can I walk and I’m breathing mostly through my nose or how fast can I walk where I can carry on a conversation with a little bit of effort but I’m not really out of breath too much ’cause that level of exercise you can do for 30, 40, 50 minutes but if you’re doing super high intensity your time is kind of limited you only be set for 10 minutes and then you’re kind of pooped out for that you can’t do much more than that but that’s sort of the sweet spot you want to hit for most your physical activity.

– Got it.

– So walk’s are great walk’s are fantastic.

– Makes a lot of sense. Here of course now they’re making us wear masks on our trails up here in Belmont. It’s yeah, it’s really frustrating because it does discourage I think people from from going out and enjoying the walk on the trail

– But Z, I wanna explain something to you. This is an interesting hack. So one way that you can rapidly increase your oxygen tolerance. So you know what they found out with elite athletes decades ago, is a one winning endurance gold medals for what the ones who train to high altitude above 7000 basically. You can mimic some of that if you actually do a few things. Number one, when you exercise in your nasal breathing, you’re kind of mimicking a low oxygen environment. And that causes your body to produce more red blood cells, you’re kind of doping your blood in a natural way. And guess what, even before this happened, I was training ’cause I told you how to have trouble for oxygen, always using a high altitude mask. So this is my Kylo Ren training mask, so basically, I would put this on and get on the exercise bike, and I gotta tell you, this has made a huge difference for me. And now in this environment, I can wear this out and I look like a superstar people like wow, where the hell do you get that mask it’s like a super secret, you know. But interestingly, I’ve had a couple patients and they’re exercising with their N95. In the beginning, they could not walk more than a block. But now they can walk very comfortably with a little bit of oxygen restriction from their mask. And that is actually a sign that they’re via to mask or oxygenation is actually improving. So that’s one hack you can actually use to assess that.

– You know, it’s rare that you see me on the show suddenly changed my mind about something. So I’ve been railing and ranting about having to wear a mask on my own trail and what a violation of my personal liberty this is. And now I’m like, well, actually, it may be better. It might be a training too. Well, you know, it’s interesting because when I lived in Las Vegas, we were at altitude of about 2500 feet, not that high, but I had a swimming pool. So what I would do is I was just long enough that I enjoyed doing laps without ever taking a breath. So I would go, you know, back and forth without taking a breath. And I got really good at that. I actually checked my hematocrit as part of a normal lab run and I was like 50 I actually had some polycythemia but my exercise tolerance was amazing. So it isn’t you’re kind of putting some stress and training at altitude, but having to suck air through an N95 might be a nice way to get those

– And obviously some disclaimers for asthmatic and COPD patients but some people honestly even it could breath holding in a limited way I have some patients that cannot hold their breath more than 15 seconds without getting into hyperventilation, right? It’s such a something, so I tell them listen, work on the diaphragmatic breathing first in a very calm relaxed way, and then maybe just do nasal breathing while you walk and gradually kind of take the slope up gently and it’s incredible what a difference and putting COVID-19 aside your energy, focus, everything gets so much better just by doing that. And that ebook, I put a list of all my favorite exercises to do so I’ll share that with you at the end.

– That’s great and to get the ebook to people have to just give their email or something or?

– That’s all they got to do yeah, it’s free. It’s what I’m using with all my Silicon Valley companies.

– I love it and one disclaimer I wanna make and Ron is a friend of mine, and he’s been on the show several times. Sometimes when we talk about this stuff, we get into that like it nervously close to the Dr. Oz style of talking where it’s like, you know what I mean, we’re both of us we’re like, okay so the thing is, if you wanna improve your, so just so you know, we’re both legit doctors, and we’re not trying to sell you anything, all right.

– I guess I wasn’t until I put my mask on right? I might lost credentials right there.

– You’re gonna sell that Kylo Ren action, you know. What’s your deal here? So keep going, Ron, educate me so, in a quick question. A quick side question here ’cause we know that diabetes is a risk factor for doing poorly on COVID. Is that for all the reasons you’re saying that it’s pro-inflammatory state or do we not just know yet?

– We don’t know yet, but you’re right. It’s a pro-inflammatory state for sure. And also we know with insulin resistance coming back to breathing and respiration, insulin resistance is intimately tied to defects and mitochondrial function and aerobic respiration. So one of the early signs of insulin resistance is actually a depressed three diminish VO two max and the reason for that is because when we’re insulin resistant, we tend to cover fat and more of a stored state. So we’re not able to adequately liberate fatty acids to fuel our mitochondria. So one interesting thing I wanna bring up is they actually did a study on breath holding times and they took people with a very elevated body weight body mass index, an elevated waist to hip ratio, which is a sign of visceral fat. And you would think that anybody with an elevated body weight would have trouble holding their breath. But interestingly, they found Z, that the people with high BMI and total weight, they weren’t that different than the control group, but it was a ones with increased visceral fat they’d actually struggled more with breath holding times. So that tells us it’s not just mechanical compression, although that can play a role. But there is something metabolic happening and I really think it is the impairment in mitochondrial function in aerobic respiration that’s making insulin resistant people more breathless. So there is some physical component, but I think the metabolic inflammatory component is a real key part of this.

– Interesting and folks like Jason Fung have talked a little bit about this as well, I think yeah. Other physicians so this is interesting because in China, you don’t have a lot of say, you know, morbid obesity, like we have here or even a lot of obesity, but you have that sort of skinny fat phenotype, right where they have visceral fat, their diet is changing, and there was quite a bit of original mortality around COVID-19, have you made any correlations here with our Asian population?

– Yeah, you’re right so I think that’s why in Asian populations, it just does take a few extra inches around the stomach and we can see that elevation, which is why I’m intensifying education of that community. But you know, one of the things is when we talk about this topic, I’ve had people flood me with emails saying do I need to get a six pack now, right? Do I need to get rid of all my fat I’ve got a lot of women saying that listen, I feel like I’m gonna die because of all this belly fat. But in a lot of women and other cultures, that extra body fat is subcutaneous, it’s not that deep store fat. So there’s not a simple way to measure that. But what I would tell you is there are some blood markers that can tell you whether your fats probably more inflammatory, and some of those blood markers are number one, if you’ve got an elevated triglycerides, or low HDL, those are the types of cholesterol markers. If your glucose is abnormal, and you’re pre diabetic or diabetic, if you’ve got fatty liver, which we’ve talked about before that’s a sign probably you got more inflammatory fat, or I don’t recommend everyone, check this but in select people, I do check and c reactive protein a highly sensitive c reactive protein, that’s an inflammatory marker. And interestingly there are studies that show I know I keep using the same term NLRP3. Actually the way to think about NLR3P is that naughty by nature song It’s NLRP3, you know me right? So just thinking about that we’ll never forget it but then NLRP3 does actually elevate c rector protein. So a lot of my patients with elevated CRP levels that’s also a sign probably got more than inflammatory fat and when they make their lifestyle and dietary changes that goes down along with the body fat as well too.

– Very important because modifiable because you down with NLRP3, oh yeah you know me dude I told you that like one of my pet peeves is every single person on the planet sends me at some point in their lifespan. Their idea for a naughty by nature OPP parody. And, I can’t tell you I’ve gotten 1001 saying, can you do you know, I’m down with PPE, I’m like, no, I can’t. You know, now I know how weird that feels when everyone asked him to do my Corona.

– It added me to the list sorry, man, I lost some credibility.

– At least you at least you used a molecule that’s kind of obscure. Everyone else is like you down with EKG. Oh yeah, I’m like, no, I’m not down with EKG. So back to this piece now. We were talking about, again about inflammatory cascade. And I think it’s really interesting that you make the distinction between subcutaneous and visceral fat. Because it’s true and it is hard to kind of measure but what can we do then if you’re thinking about actions to reduce visceral fat? Is a diet, is it exercises, is it both? Like what how can a lay person think about this?

– Yeah, so you’re right, the exercise stuff we talked about, I think is universal, you know, regardless of body type, but if you’ve got more of the visceral fat, which is more probably connected to insulin, then you do wanna be conscious about excessive carbohydrate consumption, which is getting worse now because so many of us are cooking all types of treats and doing a lot of baking. So we got to really be careful with carbohydrate intake. So I’d be focused on that. I think, you know, intermittent fasting, I know is a popular health trend, I think this is a great time to think about intermittent fasting. If you cannot control your caloric intake, can we compress it into a tighter window and avoid eating beyond seven seven, 7:30 p.m. a lot of people are doing a lot of late nights stress eating, and I tell them listen, if you can control the desserts and the baked goods and the extra carbs, at least try to finish them by six or 7 p.m, and then have that dessert with your dinner and then just close your mouth after that. That way your brains at least satisfied from the brownie or the piece of pie. But now you’re giving your liver and your body a good 12, 14 maybe 16 hours to process that and get rid of it. So inflammation markers are not as high but don’t stretch the eating until late at night. So I think those simple tactics can really help you. And the morning when you do that physical activity. Can you do some of it in a fasted state that can really help lower inflammation in visceral fat too. So I think adjusting your timing can help you get through this pretty well too.

– Absolutely and our mutual friend Peter Attia has a great framework for thinking about that, right? He says, you have these three levers you can pull when it comes to diet, and here we are in the pandemic and the lever of when to eat the time window is one lever, you can pull. So say you still wanna have that, you know, Lunardis ice cream treat, but you eat it like you said in a narrow window with your dinner and then you have a period where your body is able to burn that off and then maybe you even switch to a little bit of fat burning or ketones. If the fast as long enough, maybe you don’t but at least it’s time to clear that out. So that one level, the other level is what you eat. So what kind of macronutrients and you mentioned carbohydrates is something that if you do have a lot of visceral fat, trying to cut some of that out might help especially the refined carbohydrates that tend to promote that inflammatory insulin resistant type of phenotype. And then the third one is how much you eat right, which that one I cannot control I just eat too much. Did I miss anything there? Or any other thoughts on that? Did I miss anything that you think people.

– I think those are the big ones in the last thing, I’d say about exercise, ’cause this is a challenge I’m seeing in a lot of my patients that are gym rats, because they used to do all their lifting everything in a gym, and now maybe they’re in a small studio apartment, they don’t have access to the equipment. So one personal change I’ve made is I’m doing a lot of good old fashioned PE exercises, I’m back to doing push ups and burpees and pull ups. And I gotta say that I do feel like I’ve lost more weight, and I’ve got better energy from doing that. And you know, a lot of times we think because of muscle mass, and the more muscle mass we add on, the longer we’re gonna live. But actually, if you take a deeper look at these studies, it’s not just about strength, it’s about power. It’s how fast can you move a given a mountain of mass, which is your body. So doing springy type things, doing a little bit of plyometrics, me going outside with the boys and shooting baskets you know, doing a lot of those kind of springy type activities is really good. Rather than gosh, I can’t deadlift as much as I can, ’cause I can’t get into a gym right now. So I would diversify I think the main goal of this whole process is we’re gonna be back in our gyms and you know, eventually in some time, but how do we create these independent tools that when I’m on a business trip, when I’m on vacation, when I’m stuck in this area, now I can tap into my own body as a gym, I can manipulate my eating timing, this is a great time to learn some lessons, ’cause we’re in a controlled environment, my patients now don’t have to worry about oh, God, where are you on vacation this summer? How many times are you socializing on the weekends, you can make incredible changes now over the next several months, because you’re in a fairly confined situation where you can make these changes. And once you see the results of those changes, it’s gonna be sustainable once were released back into the wild again, right?

– I like that term released into the wild, you know it’s a crazy time man, it really is. Now here’s a question that relates to that. So a lot of people now are finding that there’s a new stress introduced in this which is you’re working from home. So there’s a few different interesting and unique stresses. One is that there’s no workday anymore it’s just work. So the work life separation is now just work life integration and maybe not a good way so you don’t control your hours as much, you don’t control your weekends as much, ’cause everyone just assumes you’re working all the time and the second thing is something that I’ve done a show about was called Zoom fatigue, where there’s a certain level of stress, having these interactions via tele, when we’re unable to pick up cues properly, we have so much attention that we have to focus like if you and I Ron on we’re sitting in a room together, we have enough bandwidth that we can read each other subtle cues, we can tune out a little bit, get peripheral vision, have a shoot the breeze whereas now it’s like you and I have to pay attention the entire time, so any thoughts on that stuff?

– Yeah, no I think you’ve nailed it. I mean, I’ve actually experienced Zoom fatigue as well too. But you know, that scheduled disruption you talked about I went through it too, I mean, it was incredible how I just forget to eat or I was working in different times. And this is a big problem because it disrupts our circadian rhythm. And the issue with that is if we’re eating at different times every day, we’re going to bed at different times. Our melatonin production is gonna be off. And melatonin is really what helps us to sleep at night, it helps us fall asleep and it keeps our schedule in rhythm. So try to make some sort of makeshift schedule. And by the way, I wanna throw out the melatonin actually, when it’s depressed melatonin is one of the key hormones that teams at NLRP3 inflammation. So when we’re looking at blue screens late into the night and stuff, we can really have an impact on the cytokines in an adverse way. But really try to set that schedule up whenever you can, ’cause that’ll help you quite a bit. We have to do this with the kids too ’cause even their schedules, if you got teams in the house, right, they’re sitting up all hours. I think they’re on their laptop doing their work, or are they doing something else God only knows. So we got to set some guardrails around our schedule.

– You know, it’s interesting cause that brings me back to that slide you showed with the two columns. Can you pull that up again ’cause I just wanna point a couple things out. So and I’ll talk it through for people who are on the podcast version. The interesting thing that Ron just said about sleep and melatonin and inflammation is super important. And Peter Attia and others have talked about, how crucial sleep is, in terms of our overall health we underestimate how important this is. And if it’s leading to higher levels of inflammation, then we’re at more risk it heaven forbid if the COVID infects us, do you have that slide? I see this as the cognitive reappraisal slide. Do we have that yeah, sorry. Perfect okay, so good so we got stress, mental health, which we talked about, tell me about meditation a little. What are you doing on the meditation state side.

– I am actually meditating more than I ever had. And one of the things so I’ll tell you one part of my health that’s been affected is the sleep part. As much as I try to be regimented about these things. Z, I found myself sometimes getting up for three or 3:30 in the morning rather than you too?.

– Yeah.

– But rather than stay in bed and ruminate, I actually go into my closet, I’ve got a little corner set up and I do some breathing and I do some meditation during that time, and I gotta say it’s been a game changer because at the end of that, I think sometimes get tired enough or I’m back in bed at 4:30, then I sleep for an hour and a half. And also, even if I don’t get to sleep, at least I got some mental rest and I did something good for my body rather than laying in bed thinking about am I gonna die tomorrow right so that’s been.

– What a great idea okay, let’s that’s brilliant. Let me go back to to your slide here. So we’ve got sleep, which we talked about. And we did on our other show I think we talked a little bit about sleep, particularly around kids and teenagers and how you reframe that’s all definitely linked to that piece. Nutrition we talked about, activity we talked about. Now conditions and visceral fat, we did talk about anything on the immune side that you wanna talk about in terms of promoting better, healthier immune system.

– Yeah, I mean, I think everything we talked about it has a direct impact on it both with the nutrition part. There are definitely specific foods that are more tailored for that specific inflammatory pathway. Obviously, we know we got to eat more plants and greens and diverse vegetables but it’s interesting how certain foods like for example, specific spices turmeric seems like it’s good for everything but turmeric is really powerful it taming that NLRP3 inflammatory pathway. If you guys are caffeine drinkers green tea with egcg green tea actually has a chemical catechins which are excellent protein guard NLRP3 inflammation so there are specific foods that are really good for anti inflammatory effects. So I’d sort of say that yeah with diet be healthier, but some of my patients that do a lot of fasting when they’re actually eating they’re not eating very nutrient dense foods, so within that eating window, make sure you’re prioritizing foods that really have impact on immunity specifically.

– It’s kind of interesting ’cause we have a nationwide worldwide shortage of yeast, because people are doing home baking, and it’s real, because I think we tried to find some and it’s interesting because then people don’t normally bake bread at home per say unless you do that now and so it does make you think we’re shifting to a more comfort menu with DoorDash delivery and Grubhub and these kind of sort of eating out, bring it home sitting around in your underwear and eating high carbohydrate refined carbohydrate foods. And I don’t think that’s gonna bode well, you know, when you look at where this thing is hitting people hard, whether it’s, you know, Louisiana where there’s a high prevalence of diabesity. And those sort of things, you know, we, again, it gives us some control to say, now we’re training for this thing, so we can make changes that might actually stop.

– Yeah, I mean, the other key point you you sort of brought up and directly is also where these patients are disconnected from the healthcare system. They’re not getting labs checked is often, you know, even the process of not going to work. When was the last time I put on a pair of jeans. We’re living in stretchy pants all day. And a lot of us know that we need two or three inches, right. So one of the things I’m doing personally is I don’t wanna be obsessive, but I do check my weight twice a day because I know the minute I start going up this threshold, I got to tailor things back. So I would say do the quantify yourself thing if you’re measuring blood sugar your waistline, your weight, your blood pressure is keep track of that. And then use telemedicine ’cause I know our medical group is totally open wide with telemedicine visits, engage with your doctor, don’t wait for four to five months to find out that oh my God, my blood pressure is out of control, my sugar is out of control because like we said at the beginning, this is no longer by 10 year risk, this might be 10 day risk, so we gonna make sure we’re on top of that right away.

– That’s a great way to phrase it. It’s not a 10 year risk anymore it’s a 10 day risk. You know, it’s weird, Ron like so part of the reason you know, we were both talking about waking up in the middle of the night and having some degree of stress and that sort of thing. And I love the idea that you that you have a meditation egg, like Darth Vader that you go to when you know shit hits the fan and you’re like okay, I’m here now I’m gonna do my breathing and that’s great I think that’s a great piece of advice. I try to do my meditation in the morning but sometimes the reason I wake up in the middle of night is I’ll have like a mini panic attack of oh my gosh, you know, I am eating worse, and I am at risk because I’m in my you know later 40s now and I have factor five leiden and pro-thrombin 2021 A heterozygous mutation so I’m at high risk of blood clotting. And so if I get COVID, I might have some of these blood and then you start ruminating on any go. And I’ve been like visceral fats getting a little worse. And that can lead to a sort of a mini sort of panic if you realize that those things can have adverse consequences or you can go okay, so yeah, it’s distorted thinking to catastrophize about that, but it’s not the sort of thinking to go okay, then I’ll just make a mental note in the morning. I am going to make sure to try to that day to eat in a narrower window, and maybe, you know, one less slice you scoop of that ice cream, whatever it is.

– Right, right and you’re remembering past talks we talked about okay so I overfilled my muscle parking lot, right? So if I overfilled that lot, tomorrow, I don’t need to eat breakfast. So I’ll go for a nice 30, 40 minute hike because guess what, I don’t have to drive to work anymore. I’ve got time on my schedule I’m gonna do that first clear out some space and then come back in. So you did a beautiful example of cognitive reframing right there, instead of oh my God, I’m gonna die. I’m gonna take control and do something corrective, and then sort of move on. That’s really a critical shift in thinking.

– Yeah, you know, what’s interesting to Ron is in the old days, and again, if you have a disordered eating pattern, or you have some other issues intermittent fasting and the time, window stuff can be very tricky and we don’t you know, again, you have to talk to a doctor. But for me having that toolkit of saying, you know what I am not gonna eat breakfast or lunch today, I’m only gonna eat dinner, because I really fell off the wagon a little bit today and I feel like every yeah, every muscle is full of glucose, my liver is full of glucose and I’m overflowing into fat. Well, okay at least I can feel better the next day by allowing that to then empty out a bit and then eating a sensible dinner in the evening so.

– Exactly.

– You have that control.

– Yeah, absolutely I think you have that control. The other trick I wanna teach you again, despite me doing all this, I also I grew up on a lot of carbs and sugar. So one of the things is knowing that meal combinations can mitigate some of the damage. So if I’m feeling like having that minorities ice cream if I actually put some berries or had some berries on the side, if I had some other healthy foods around that, it’s gonna limit the glycemic spike. So when I get a chocolate craving, I’ve got the 70% dark chocolate chips, I put it on Greek yogurt, and then I’ll get my chocolate fix while I’m having that with Greek yogurt and some berries. So meal combinations can mitigate some of the effects of just having a pure junk food itself. If it’s a little bit of chips, but on the side, you’ve got some salad or something, just think about creative ways that you can mix the right foods around the wrong foods to limit some of that inflammation. You know, there was one study that actually showed with inflammation, if you had a big mass burger basically, versus having the burger with avocado on top of that the avocado actually limits vasoconstriction and inflammation. So that’s the way you sort of think about if you’re growing a lot of meats, how do I add veggies around that to sort of mitigate those impacts.

– You know, it’s funny, I’ve instinctively done that and then I always question that I’m I just adding calories to calories because you put a slice of avocado and now I’m just adding more fat and calories, but it’s different, it’s good fat, it’s also a lot of anti inflammatory for the reasons that you talked about. And it slows overall glycemic index by changing the absorption pattern of the food. And when you mentioned berries, I wanna really put a point on that one, because I personally have found that and the problem with berries is again, they can be expensive, especially if it’s not in season. So you do it’s a little bit of a elite position to tell people to eat a lot of berries. But if you can get them and they’re good they really do. First of all, they can satisfy a bit of a sweet tooth without a high glycemic index, they’ll have a lot of fiber, and they do seem to change the pattern of absorption of stuff that you eat with them. So they’re and they got antioxidants and all the other you’ve addressed, yeah.

– Absolutely, and a quick hack for that too. And I agree with what you said about the economics of berries, but at Costco, we sometimes get the big bag of frozen organic berries and white real quick breakfast is sometimes I’ll get Greek yogurt, and I’ll put the frozen berries on my Greek yogurt it almost feels like you’re having ice cream because it’s cold already. But even in the frozen state you’re getting a lot of locked in nutrients so I know a lot of us don’t wanna be going to the grocery store very often and berries can go bad quickly. But you know frozen options are okay for fruits and produce, you still are gonna get some nutrients from them.

– That’s great that’s great. So any other things you wanna make sure that this audience.

– Oh, yeah I got one last thing and this is a little bit of a tribute to you as well.

– Oh, good Lord.

– All right, so this, I call you the triple threat or the triple team, honestly the number one you are always providing knowledge. So you’re helping us activate the prefrontal cortex. Number two, you’re providing laughter which you’re doing right now so that’s diaphragmatic engagement and we know laughter activates the parasympathetic system and the third is music. I didn’t pull up this study, but there’s a couple of studies that show that the more we listen to music, it can actually start suppressed cytokines including interleukin eight and six. So you’re providing triple therapy I mean, a lot of times I tell people, if you’re looking at stressful news, make the environment better play your favorite songs in the back and just try to take the edge off the stress don’t be in a room in a dark room under your cover is looking at all this stuff, we can change those cues but I wanna personally thank you on behalf of my patients, people that I sent to you, you put a lot of work and energy into your work and it’s helping heal a lot of us in this tremendous environment so just a personal thanks to you for that.

– I’m rarely speechless Ron but–

– I don’t have ever seen that before.

– You took me by surprise with that one I’m really honored and touched and it makes me feel like I shouldn’t be billing an ICD or CPT code for my services. They’re gonna forget about selling out to Big Pharma. You’re selling out to big ZDogg. You know what I mean? But it all joking aside like what you do and when I read your book, and looked at your website and we first met really and engaged on this stuff, I was just blown away by how much you are really helping people in a way that a lot of doctors haven’t been trained to do and you had to up speed yourself on this stuff and you do it in a way that is never you’re never selling anything you’re never dogmatic and you always are humble in the face of what we don’t know. And I think that’s what really gets me excited about getting you on the show and I’d love to have you back assuming that you’re in good shape to survive COVID because.

– I hope so.

– You and me are having a COVID party so we can get a million right, right bro?

– Actually you’re right we got to do that.

– There’s gonna be a front page news if like you know fierce healthcare or one of these like healthcare journals like too.

– Mask only man you got to show up with this. This is your coverage.

– Mass out, mass out that’s right, that’s right they’re gonna be like two top, you know, internet doctors dead of hubris for self infecting with COVID.

– Oh my God and you know, I did most of my growing up in Bakersfield, my Mom’s there. So that was a, that was a rough news clip when that came out.

– Dude and you know, I grew up in Clovis, which is down the road, right? So we were yeah, we were Central Valley neighbors. And dude, I mean yeah when I saw that the thing is you know, and the thing is, I really wanted to believe them, and then just have a science man, that’s the problem. You really can’t speak with that level of certainty, without really having your data, right.

– You got it yeah, that’s why we need people like you doing the work you’re doing, thanks for that.

– Now dude likewise, likewise, brother, so okay so what’s your website spell it out for us?

– Yeah, so it’s It’s a mouthful, but you know, I put up just as an FYI let me just get this right here.

– Perfect.

– I put up my resources, you know, because I like teaching people with videos so much. I’m actually launching a co-video series where I’m actually putting short three to four minute instructional videos that teach people these concepts. I call it sinhacovideos. So in the ebook, like I said, it’s just a free resource for the community and for corporations, so I’m updating that with new breathing practices, my exercise Arsenal, all these things. So hopefully, these can be resources that will benefit you. I’m not selling snake oil on these. This is purely to educate people around the world. So hopefully that’ll be a helpful resource.

– I love it dude that is fantastic. And I will send everybody to your resources because they are legit, too legit, too legit to quit.

– On that note

– If you’re on that note, I think we did a thing here. This was so much fun, Ron, thank you, Zpac, listen, go to the website I’ll put the links in here. This is an actual call to action that you’re training for this thing. You have a horizon, let’s say it’s a couple weeks where you’re gonna get in shape. You know, we feel so powerless, right that we’re not we don’t have enough PPE that we’re going to work putting ourselves at risk but here’s the thing. There are things you can do to keep yourself and your family safe and it’s stress reduction, sleep, diet, exercise, these kind of things that we’re talking about will put you at in the best position. If heaven forbid you actually get infected and not only that, but it’s gonna put you in the best position for life after COVID which believe it or not, despite all the catastrophizing, Ron, there is going to be life after COVID right?

– Agreed, agreed

– And on that note I would love to ask you guys to share this video with anyone you care about please, please, please leave a comment. Have your voice heard subscribe to the show all that other stuff, I love you guys stay safe and we out thanks, Ron again. See you next time.

– Thank you, stay safe buddy.

– Peace.

Related Videos