Welcome to episode 412 of The Whole View. On this week’s episode, Stacy and Sarah host a covid-19 FAQ, part three, in our traditional “rapid-fire” style. Learn about how quarantine is impacting our gut microbiome, if healthy habits and supplements can lower our risk of getting sick, and if science has advanced on what we know about antibodies and immunity. All of this and more in episode 412!
If you enjoy the show, please review it on iTunes!
The Whole View, Episode 412: Covid-19 FAQ, Part 3
Welcome back to the Whole View, episode 412. (0:27)
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The Weekly Serving Matrix is very helpful! I’ve been eating along these lines but this really helps me know where to focus vs. which foods serve a more secondary role. It’s super helpful and has taken a lot of worry out of my meal planning. Thanks!Jan
Stacy was just talking to Sarah about how discussing covid again is not mentally what she wants to do because she is ready to move past this.
In America, covid is not trending in our favor.
We do have a couple of questions that we are going to get to, but before we jump into that, Stacy has some exciting, positive news to share.
As mentioned previously, Stacy’s family has been going through foster training.
Early this week, they officially received approval to be resource parents for foster care.
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I’m very excited about the Nutrivore information! Thank you so much for all your research and hard work you put into this kind of information for all of us to use!!Debbie
It is such a light among all of the darkness 2020 has brought.
They started this journey in November 2019.
This has been something that has brought Stacy hope and makes her feel like she can make a difference.
It is one of those things that Stacy felt called to do, and she is glad she followed her instincts.
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I never realized how important nutrients are and how intricately the body works! I can’t thank you enough for sharing all your knowledge and insights.Cheryl
The process was drawn out because of covid, but they have finally been able to move forward with everything.
They hope to welcome some youngsters in need of a safe, stable home in the near future.
Stacy will not be sharing anything about the kids moving forward, but she shares this announcement in the hope to inspire others to participate in foster care.
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One of my FAVORITE books I used to start the transition to AIP!!! It’s so helpful! I printed mine out and spiral bound it. Thank you for this!Rita Davidson
It feels as if there is a stigma around fostering, and this is a time in the world where people who live in less than ideal situations are more than ever in need of safe, stable homes.
If foster care is something that resonates with you, please look into it as there are so many different ways you can do it to fit your abilities and lifestyle.
You are welcome to email Stacy at [email protected] and she can share her experience with you and answer questions.
Stacy genuinely feels like there is such a need for this right now.
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The depth of information, practical tips, and the accessible way Dr. Sarah shows me how to apply complex science to improve my health is truly remarkable.Wendy
Covid-19 Q & A Series
We have a series of questions that will touch at different aspects of covid and our response to it, and our way forward. (5:02)
Sarah will also share the latest science available.
She hopes that this is a show that answers some of the common lingering questions that have been floating out there.
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The Gut Health Cookbook is fantastic! Thank you for researching and creating The Gut Health Cookbook! Such wonderful recipes! I’m so excited to try them all!Sue
Thank you to everyone who sent questions and for utilizing this show as a trusted resource!
They take this role very seriously and put a lot of effort into the research that goes into this show.
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I love Dr. Sarah’s passion for educating people and helping everyone on their journey to wellness!!Mindy
We hope that you continue to come to us with your questions, and understand that sometimes the answer to your question is ‘we don’t know’.
Sarah wants to start this episode with an email that we received from Cathy.
This email encapsulates our experiences in many ways.
“Thank you so much for your podcast!
Living in Wisconsin where the cases are going up but everything is open my husband and I have chosen to stay isolated.
I have not been in a store since March 13, except for two medical appointments and that is it, and I wore a mask for those.
I am 59 years old but feel I am at a higher risk because I am on Humira for RA, have fatty liver disease even though I have never been overweight, have heart and kidney issues both related to birth defects.
My diet is AIP, and with a few introductions, I have been in remission for over 2 years.
I have been feeling pretty down the past few days as I had to miss our youngest grandsons 1st birthday party.
While I did attend virtually, my adult children and 6 grandchildren are not practicing social distancing, so missing them has been heartbreaking.
We do play in the yard together occasionally but maintain our distance.
It is so hard not hugging.
I do get out for a walk daily, do many crafts so I have been sewing, painting, etc.
I just wanted to thank you for giving the information to continue believing that my husband and I are on the right course.”
Stick With It
Stacy has such empathy for Cathy. (7:56)
We commend Cathy for sticking with it.
Stacy knows it is difficult and has been there personally.
It is so painful to turn down family gatherings.
Stacy is happy to hear that Cathy is getting outside, and engaging as much as she can because this will not end anytime soon.
We have to find ways to physical distance.
However, we are social beings and our emotional well-being is so dependant on our emotional connection with others.
Stacy hopes we can continue to find ways to do this.
If you are at risk, it is so hard
And while we are grateful for all that technology gives us access to, it still sucks to have to miss out on opportunities.
Sarah felt it was important to start this episode with Cathy’s comment.
It is important to understand how common this experience is.
This feeling of stress around being someone who is taking precautions, and feeling like we are missing out, these are real challenges.
It is hard to be physically isolated in our homes, and then we have these doubts wondering if we are doing too much.
This self-doubt magnifies our feelings of missing out.
Sarah wants to emphasize that these feelings are common and it doesn’t take away from how important it is to continue to stay at home, social distance, use our mask, and wash our hands.
Know that we are together in our aloneness.
Help yourself focus on the positives.
No matter your circumstances, we can all relate and know that you are not alone.
Let’s start with Jeanie’s questions for our Q & A! (16:04)
Jeanie writes, “Dear Stacy and Sarah, thank you for your most recent podcast on covid.
I know you must be tired of talking about this, but it was so helpful to me, mostly to know that I’m not the only one still concerned about this virus.
I live in Missouri where cases are increasing and officials are not taking the virus seriously.
Although my hometown of St Louis was mostly following science at the beginning, now that our local cases have fallen, half the population has gone back to life as normal.
Like Sarah, I feel so much dismay that science is being disregarded and that this could all be done so much better!
I’m so frustrated that we are living in a time where experts are demonized and people make up their own truth, facts, and reality.
Masks should not be political, but that is exactly what’s going on in Missouri.
Except for Trader Joe’s, most local stores have too many unmasked individuals, and as Sarah experienced, they do not respect “turns” or personal space.
I only have one child, a 10-year-old daughter and she is so lonely from not having any playmates, but like Stacy, my neighbors are not taking the virus seriously enough for her to play with them.
It breaks my heart to watch my daughter watch them all play together in the cul-de-sac in front of my house.
It will be such a hard decision about whether she will return to school in the fall or be socially isolated indefinitely.
A neighborhood mom told me she was going to tell our school board that she won’t send back her kids if they require masks–because she believes masks are dangerous to her kids.
My Facebook friends that live in the suburban county next to St Louis are posting pictures of their kids at dance competitions, ball games, and swim parties.
Even those who were so worried about the virus a month ago!
My family is looking around at all this and have begun to question me that we need to be so careful.
I was really starting to feel gaslit, especially when we saw the chiropractor.
She spent the entire hour trying to convince me that we shouldn’t wear masks.
I didn’t believe most of what she said but I didn’t know up from down when I left her office.
She really had me questioning myself and my decisions.
Your podcast brought me relief and validation.
The chiropractor did say one thing that has been bothering me that Sarah may be able to answer.
She says that it’s very bad for our immune systems to be socially distancing, that when we all come back together it will be disastrous.
I know that historically native tribes have been killed off by the arrival of European diseases they’ve been isolated from for tens of thousands of years, but are you concerned that you haven’t shared any germs with someone outside your family for 3 months?
What about if this goes on for a year?
Also, I wanted to say that I appreciated the science on how protesters are not spreading the virus and how you have come out in support of Black Lives Matters.
It was the right thing to do.
Being a Parent During a Pandemic
Stacy adores Jeanie, and Sarah for not taking any breaths while reading about what the chiropractor told her. (19:17)
This has been an issue in Stacy’s neighborhood and it is fascinating.
Virginia is kind of in the middle.
Masks are required legally everywhere in public.
This is not being respected by everyone.
Matt and Stacy have had to sit down with their kids as a family to discuss this, especially because Matt has the risk of continued exposure.
We don’t know enough about the virus to know if people could potentially get it twice, and what that impact is.
So they have made it clear as a family that they are not returning to life as normal.
Stacy was very nervous about going glamping, but they followed certain rules that they set for themselves.
They carefully discussed their travel plans and knew the risks, but they did not want to extend that to additional gatherings.
It makes it harder to be a parent.
Being a parent during this has escalated this to such a higher extent.
What will this generation be on the outcome from this all?
If you establish what the rules are for you and your family upfront, it makes it that much easier to define what you can and can’t do and why.
Stacy shared on their experience with birthdays in quarantine, video game virtual socialization, and ways they can connect kids that are not physical.
Sarah has been doing the same.
All of the topics related to the masks myth that Jeanie referred to in her question were covered in this podcast episode.
Please also refer to this post from Sarah on mask use.
What isolation is doing to our immune systems is something that Sarah wants to address. (27:02)
We received a similar question from Dawn, so Sarah wants to read that question and then address both questions together.
Dawn says, “wondering if you’re concerned about isolation and how that is affecting all our microbiomes?
Gut health has always been so huge for you, so do you have any articles or podcasts on gut immune health related to surviving Covid-19?
And do you expect a surge of illnesses related to suppressed immune systems after isolation?”
All of this is linked.
This ties into the original version of the hygiene hypothesis. (27:38)
As originally proposed in the ’90s, we needed to have this exposure to pathogens, especially early in life, to help educate and shape the immune system.
What has changed about this hypothesis in recent years is the understanding of the gut microbiome.
So this entire hypothesis has blended with something called the Old Friends Hypothesis.
That actually the thing that we need exposure to is not pathogens, but rather this diverse range of microbial exposure to seed our microbiomes.
The Old Friends Hypothesis even recognizes that there are some parasites that our immune systems have coevolved with over millennia.
It is not just that we need that exposure, it is that our immune systems actually require the continued presence of these microorganisms in order to fully develop.
What we really need is this acquisition of a diverse microbiome and where hygiene has steered us wrong is our overuse of cleaners and disinfectants.
This has made our environments so sterile from probiotic organisms, especially environmental probiotics.
When we overclean our environments and we are not getting exposed to a diverse species of microbes, this lack of seeding in our microbiomes can result in an overactive immune system.
This is one piece of this puzzle.
There are a lot of studies showing that social isolation and loneliness can impact immune function.
That mechanism is not related to the gut microbiome.
The studies show that this is a neuroendocrine mechanism.
We talked about this in TPV Podcast Episode 382: Social Media and see The Health Benefits of Connection.
So we do see that social isolation and loneliness can impact immune function.
Sarah thinks that the heart of this question is touching on physical isolation’s impact on immune function.
Suppressed Immune Systems
We have talked about ways we can try to stay socially connected while physically isolated. (31:19)
However, there are not many studies about what happens to humans when they live in a sterile environment.
This is because there are so few, truly sterile environments in the world.
On Earth, there is no such evidence, but the astronauts on the space station do have a suppression of their immune systems.
Studies showed that after about 90 days on the space station, especially first-timers, they have about a 50% reduction in the activity of natural killer cell activity.
These are a type of cell that go around and find cancer type cells and virally infected cells.
They then force these cells to basically commit cell suicide.
These are very important cell types for our immune systems, especially in terms of cancer risk and viral infections.
For the astronauts, there are three proposed mechanisms: stress, microgravity, radiation (not, lack of infections).
The big risk to astronauts, besides cancer, is persistent infections.
We are never actually not exposed to pathogens because we carry them with us.
There’s no evidence that hermit living on Earth causes immune dysfunction.
Although once you re-emerge and have contact with people, you wouldn’t have immunity to viruses that circulated while you were cloistered.
So exposure is what would increase the likelihood of infection, not immune suppression.
The good thing is that we are currently suppressing the circulation of all those other viruses and bacteria right now.
What can we learn to take beyond this pandemic into our normal cold and flu season?
If we can physically isolate at the first sign of symptoms, rather than our current societal norm, we could be preventing a lot of regular viral illness, including death from the seasonal flu.
By also adopting more of us handwashing as a lifelong habit, we could evolve our norm.
Yes, when we get back together there could be some other viruses that we start sharing.
However, it is likely to be fairly slow build since we have taken ourselves out of circulation for all of these different viruses.
If we are physically isolated, is it impacting our gut microbiomes? (39:34)
The most important determinants of the gut microbiome are diet, nutrient status, and hormones, which are a reflection of your lifestyle choices.
So these are the most important thing.
There is an effective exposure, which we see in studies of family groups.
We know that baboons, the closer their relationships are, the more physical interactions they have, the more common their microbiomes are.
This is seen in humans too.
Married couples who report having a close relationship, will have more similar gut microbiomes to each other than siblings will.
This is a reflection of the fact that whenever we touch a person, we are sharing our microbiome.
There is potentially an effect if kids are not getting exposed to some bacteria by not being at school.
However, this is a very small effect on the gut microbiome compared to the most important thing of a healthy diet, no nutritional deficiencies, and a healthy lifestyle.
All and all, Sarah’s process for looking after her gut microbiome through physical isolation is no different than at any other time.
Work on social connection even with physical isolation.
Get Sarah’s new Gut Health Guidebook for optimal diet and lifestyle information.
Incorporate probiotics like Just Thrive Probiotic and/or fermented foods
And incorporate nature time if you can get is safely.
There is no evidence that our immune systems are going to be suppressed by a year of living in our homes.
And there is no evidence that our gut microbiomes are going to suffer.
The things that are more problematic are the impacts of feeling lonely and socially isolated.
This part can suppress our immune systems and can reduce the diversity of our gut microbiome.
Stacy and Sarah took a moment to discuss examples that show that no one lives in a sterile environment.
Jessica’s question is a really good follow up to diet and lifestyle is still important. (52:25)
She writes, “I know you both said you don’t want to do COVID episodes every week buuuutttt, I have a COVID question.
I’ve seen this article passed around along with the general idea that if we pushed real food, metabolic balancing, and immune support, the death toll from COVID would be much lower.
In conjunction, there’s been criticism of the messaging from media the only pushes vaccines, drugs, and basic immune support.
I know this is an oversimplification, but in the spirit of science literacy, I’d love to hear your more nuanced view of why this is or isn’t a feasible solution.
I’m sure you get lots of questions, but thank you for your science-based approach to whole living!
I’m an academic librarian (aka info junkie) recently diagnosed with early-stage Hashimoto’s (no medication but high antibodies) so you and Stacy are a god-send!”
Stacy thinks that this gets to the root of what we discussed on our last covid show regarding the mixed messaging in the community.
Sarah has some science to jump into, but Stacy wants to state that you don’t have to pick and choose.
Covid can infect anybody in any health situation.
Stacy strongly feels that the things we talk about with gut microbiome, sleep, lower stress, healthy eating, and anti-inflammatory lifestyle choices, that this is good for you and your immune system.
However, this still doesn’t make you immune from covid.
There is no diet or healthy lifestyle that would prevent us from getting covid or even guarantee that we wouldn’t have a severe course of the disease.
We need to figure out a way of communicating healthy choices that don’t take away from the messaging around the importance of social distancing, masks, physical isolation, and a safe and effective vaccine.
There are so many barriers to adopting a healthy diet and lifestyle, broadly across our entire society, that we faced before this pandemic.
It is a multi-dimensional challenge that needs to be overcome.
Nutrition & Covid Risk
There is now data showing some nutrient deficiencies are problematic. (1:00:24)
Very low selenium intake increases death rate from COVID-19 by 5X.
The science behind this can be found here.
There is some initial research being done on the impact of supplementation on covid.
A combination of B12, D, and magnesium was administered in older COVID-19 patients.
This was associated with a significant reduction in the proportion of patients with clinical deterioration requiring oxygen support and/or intensive care support.
This is a small preliminary study and has yet to be peer-reviewed.
There’s also an ongoing study looking at combo vitamin C and zinc.
This is an area of active research with a lot to still learn.
However, vitamin D is probably the most relevant nutrient and something that could be incorporated very simply into a national message.
Amanda writes, “Love all your recent podcasts on covid. (1:02:54)
I’m so glad Stacy and her family are doing well.
Sarah your research is the topic of many conversations with my family and friends.
Recently I read an article talking about a link between low vitamin D levels and covid.
Just wondering your thoughts on this.
What science have you found to supposition or dispute this if any?”
Sarah wants to first provide some context to this question.
There is a very well known blogger who came out in early March with an eBook that made a case for avoiding vitamin D supplementation.
They said that it increases the ACE2 receptor, which is the receptor that the novel coronavirus is binding to, to enter our cells.
Sarah has received a ton of questions on this research.
Recently there has actually been a huge increase in studies linking low vitamin D levels with an increase in severity of covid.
The first few studies were done at the population level, which means it was hard to identify cause and effect.
So they were correlating country/territory latitude or average vitamin D deficiency rates with mortality rate, varying results, from null to double mortality rate.
The results were varied, which you can read more about here.
Now, there are studies where individuals have vitamin D levels measured.
It is showing that there is quite a large effect.
Vitamin D & Covid-19
There have been quite a few studies that have looked at this. (1:05:38)
One analysis that is just being published now, shows that this might be as much as a factor of 2.
So having an adequate vitamin D status halves the mortality rate, compared to having vitamin D deficiency.
There have been studies that have actually looked at vitamin D deficiency versus insufficiency.
Backman said, “It will not prevent a patient from contracting the virus, but it may reduce complications and prevent death in those who are infected.”
For more on this, see here and here.
Testing positive for COVID-19 was associated with increasing age and being likely vitamin D deficient, as compared to likely vitamin D sufficient.
Sarah shared the data from this study.
Please also refer to this study and this study for more information on the statistical analysis that was carried out using Mann-Whitney.
When you look at this collection of studies, it has just in the last month become really clear that low vitamin D is a risk for severe covid and death.
Even these studies are suggesting these really high-level doses of vitamin D to address this prevalent deficiency.
There have been some studies showing that perhaps one of the reasons why the rates have been lower in the northern hemisphere in the summer is related to the fact that when people are outside their vitamin D levels go up.
The ACE2 Receptor
ACE2 is an enzyme that is membrane-bound. (1:10:46)
When a respiratory droplet containing SARS-CoV-2 enters your mouth or nose, it’s easily inhaled into your airway where it encounters pulmonary cells that have ACE2 enzymes embedded within their surface membranes.
ACE2 is a type I transmembrane metallocarboxypeptidase that degrades angiotensin-2, thereby negatively regulating the renin-angiotensin system to lower blood pressure.
ACE2’s role in regulating blood pressure is why hypertension is such a major risk factor for a more severe course of covid-19 illness.
It is also found in arteries, heart, kidney, and intestines.
The now infamous spike proteins on the outside of SARS-CoV-2 bind with ACE2, releasing the fusion machinery that the virus uses to dump its RNA and viral proteins into the target cell, where it hijacks the cells organelles to produce viral replicas instead of all of the various proteins that the cell needs to survive.
It’s true that vitamin D increases ACE2 in various models of pulmonary injury, hypertension (see here and here).
So the simplistic view spreading across the internet is to reduce ACE2 with vitamin d deficiency and you can’t get infected.
WRONG! Not only is vitamin D critical for the immune function to help fight off the virus BUT increasing ACE2 in covid is a REALLY GOOD THING!
The truth is the complete opposite.
It is very very important to test vitamin D levels, and supplement to bring your levels up to normal.
Researchers are suggesting at least 60 nanograms per milliliter as a target.
This is a discussion to have with your doctor.
The whole argument of avoiding vitamin D because it increases ACE2 is completely backward.
You are not going to reduce ACE2 with vitamin D deficiency to a point where the virus can’t get in.
It can get in no matter what.
Covid-19 normalizing ACE2 levels in the context of lung injury is very very beneficial.
For more information on this, be sure to also reference this article and this one and this one.
This is a reminder about the importance of making sure your information is correct before putting it out into the world.
Covid-19 & Minority Groups
There have been some comments online that the reason why the Black community has been so much more affected by covid is that they have a higher likelihood of being vitamin D insufficient. (1:20:50)
This is due to the higher levels of melanin in their skin.
You can read about this here.
In this study, sex and ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels or socio-economic factors.
Mary asks, “I have a question about covid19. (1:22:55)
I was sick March 9-29 with fever and other wonderful symptoms!
Doc told me I probably had covid19.
Thankfully I wasn’t sick enough to be hospitalized (or tested here in GA) and I’m finally feeling much better.
Still tired and having more RA pain but trying to ease AIP with reintros!
Hubby and I (both 62 yrs old) got tested for the antibodies, and we’ve both tested positive.
Everything on the web is saying they don’t know if that means we’re immune to the disease or can get it again.
My in-laws (95&94) live in KY and we’d love to go see them and the rest of the fam.
Should we just continue to live our face masked life (we still wear them inside the grocery in consideration of others) and not visit?
We are interacting with a small group of neighbors in the hood, playing pickleball, but washing hands and wiping down paddles and balls, etc… no hugging, no high fiving, somewhat social distancing (not perfect).
We don’t know anybody else that has had covid19 or had symptoms.
Wondering if you’ve found any research concerning immunity and contagion if immune?”
The science part of this question is that we don’t really have a good sense for how long you might be able to shed virus after your symptoms go away. (1:25:35)
There is some research showing that people can shed virus for at least 24-days, and more public health officials are trying to talk about this.
The suggested 14-day quarantine period is likely insufficient.
Based on what officials are recommending, you should quarantine for 14-days after symptoms end.
Even that might not be enough.
There have been cases where people have tested positive for months.
Some of these people have been sick for this whole period of time, and this is another thing that we don’t yet understand.
We don’t know how long you are contagious for, and we don’t know how long immunity lasts.
This piece of the question is unfortunately something we can’t answer at this time.
We don’t know if having antibodies (or what level of antibodies) is enough to protect you from reintroduction.
And we don’t how long after your symptoms end before you are no risk to the people around you.
This makes making a decision on how to handle life post covid really hard to navigate.
Stacy thinks the hardest part for them was sending Matt back to work.
As Matt and Stacy returned to life after they were sick, they did have to have dialogues with people about how they were handling things given the unknown.
Communication is essential.
Matt and Stacy did their best to clean their house after they were sick, but it is not a personal skill of Stacy’s.
More than 30-days after Matt and Stacy were symptom-free, they decided to ask their long-time house cleaner to return after having a conversation with her to determine her comfort level with returning.
If you have had the virus, there is no stigma with it, but you need to let people know.
It is only fair that others know your information so that they can be careful.
Stacy’s takeaways after being sick were to quarantine for as long as possible and to communicate with people.
Sarah applauds Mary for still wearing a mask to both be considerate and be a role model.
It has been a doozy of a show!
Stacy and Sarah want to thank all of our listeners for submitting questions.
And a huge thank you to Sarah for pulling all of the science together.
As mentioned last week, we do have something coming for you in the very near future.
Make sure to stay tuned, join our email lists, and we will be connecting with you more on this very shortly.
We will be back again next week.
Thank you again for listening, we know this was a long show.
We appreciate those who have stuck with us! (1:38:25)