The Johnson & Johnson vaccine just got FDA EUA approval. Here is a summary of what we know so far.
Today I’d like to talk to you about part 3 of fatigue, low energy and stress. We're going to be discussing today more about this important topic. I asked you some questions two weeks ago on whether you had energy to accomplish your goals or whether you're satisfied with the level of energy that you have now or that you see other people having more energy and that you'd like to have more energy yourself. I asked you if you had to get through the today with more caffeine in energy drinks and I told you about why fatigue is a major problem not just problems of accidents that can occur from sleepiness at the wheel but also the lost hours at work. So we discussed this in the first part. We also talked about what other aspects of what comes about as a consequence of low energy. We went through some of the causes last week. We had discussed examining energy problems in the functional medicine realm and I mentioned three myths or misconceptions. The first misconception is there is only one cause and fixing that one thing would fix everything. In reality, of course you want to focus on all the causes and to think outside the box because there may be some other causes that we haven't addressed. If you are able to address all the causes then you have a successful outcome. We looked at low energy, fatigue, and stress with the three main causes: infections deficiencies, and toxicities/inflammatory triggers. When we find the causes, we address each one and only then we can have a successful result. That’s why it's important that we need to find all the causes. We need a systems approach to make this work. We're going to talk about the second myth today which is the focus on laboratory studies to find the infection, deficiency or toxicity. This strategy is based on the axiom to test not guess. The numbers of what the lab test show doesn't necessarily reflect the whole story. So the story or whole picture is the most important part of the detective work of determining what the causes are and how best to approach addressing the cause. Also, a normal value on a lab doesn't necessarily mean an optimal value. For example, Vitamin D levels show up as normal levels on a scale that is between 30 and 100 nanograms per milliliter but the low end of “normal” which is 30, is more like the minimal recommended daily allowance or the minimum amount just to get by. In the example of vitamin D you’re closer to optimal levels between 40 to 80 nanograms per milliliter. Breaking this down further if you have 60 nanograms per milliliter your mood and immune system response is much better and if you're closer to 80 nanograms per milliliter then you'll have a reduced risk of cancer because your immune cells will be optimized for surveillance. It's very important that you realize that normal ranges are just describe where people in the middle of the bell curve are at and that there are outliers with some people needing to be higher in order to be to be in the optimal range. Some people can be in the normal range and have adequate levels because of their medical reserves or health. We need to know that the story of where you have been and what's happened to you and factoring in childhood history gives us a Terrain or landscape on which to compare lab values. Instead of soley relying on lab tests, we need to put things in context of one’s story and one's evaluation. Eighty percent (80%) of the time we actually can make the diagnosis or figure out the causes based on the history. So I'm asking targeted questions based on experience and the medical history and story. An experienced medical detective is vital to determining all the causes. Labs, on the other hand, may give you false information if the sample is not collected correctly, properly stored or quickly processed in the right way. Relying solely on labs is kind of like flying an airplane with just the instrument panel and not having the overall perspective or view of the horizon by looking outside the cockpit window and seeing where the Horizon is. To orient yourself there may be multiple ways and the best is to use a combination of techniques including focusing in on the story and the history. We want to treat according to the causes that actually will result in the symptoms. With the focus on symptoms we can track and adjust the treatments based on the improvement or resolution of the symptoms. We can also confirm and monitor the supplements and treatments with labs as needed so we can see where the treatment is successfully targeting the symptoms and seeing some deficiencies being addressed by improved lab values. Here is a list of deficiencies that can cause symptoms that we can ask questions and determine that these areas are problematic.
´Good Food (healthy, non-toxic)+
If we're not sure we can always order lab tests to confirm. For example for adrenal problems or stress we can look at salivary cortisol level but you can also determine how one's energy level is in the morning compared to the afternoon or evening by asking targeted questions. You can also address nutrition by asking questions about what you're eating, whether it's healthy, organic or sprayed with pesticides (environmental working group dirty dozen list). Questions can be asked about the amount/ quality of sleep and also measure melatonin. Questions can be asked about testosterone in regards to how much energy and muscle tone or stamina and we can verify with testing by measuring Testosterone.
These are a list of deficiencies that we see more on testing more than just asking about symptoms.
´Vitamin B12 --
´Vitamin D –
Symptoms of folate deficiency and iron deficiency may not be obvious initially as it might take quite a bit of time for iron to be low enough for you to see anemia, feel fatigued or look pale. Vitamin D is very important as well and people may not know they have low levels. Symptoms may not be noticeable or obvious and include mood issues like being depressed. Toxicities seen with symptoms and confirmed with tests include the following:
Symptoms like constipation are fairly obvious but the cases can confirmed with tests for example bacterial overgrowth or thyroid studies. Examples are electromagnetic frequency from electronics, cell phones, towers and food allergies or food intolerances that can lead to headaches, fatigue, skin rashes with trials of an elimination diet or food allergy panels for antibody testing . Infections that that have symptoms and that can confirm be confirmed with tests are as follows:
´Ehrlichia or Anaplasma+
´Epstein Barr virus+
Certain symptom patterns are seen in intestinal infections like diarrhea and other symptoms of bloating from bacterial overgrowth after antibiotic use that can be confirmed with tests such as a breath test. I want to emphasize is that not just the testing but it's also the questions and the detective work that's involved trying to help and that's why the strategy just testing and looking is insufficient. It's more than just testing and looking for abnormal levels or numbers but it's asking the right questions about the symptoms, looking for symptom patterns and then going to treatments. We will touch on the strategies for treatment next week.
I also wanted to go over updates on COVID-19. Let’s discuss 2 new studies that show the risks of eating at restaurants and the Bradykinin hypothesis. The first study looked at community and close contact exposures associated with covid-19 among symptomatic adults over age 18 in 11 outpatient health care facilities. This was the study done in July of 2020 where the researchers interviewed people that were exposed to COVID and then had confirmed covid-19. They looked at these major 11 major Healthcare facilities and they found that in the positive covid-19 cases we have to make more efforts at reducing exposure wearing masks and social distancing . The activity that stuck out when reviewing the anwers to questions was that twice the number of people had eaten out compared to those found not to have COVID. This implies that when people have difficulty wearing masks and social distancing such as went they are eating and drinking they have a much higher chance of acquiring COVID 19 if exposed. It’s important to keep in mind that in the past week New York city has opened up for indoor dining. This study seems to the show that that is still very risky behavior. Unfortunately unless you're in a population that's closer to herd immunity, this risk of eating out at restaurants will remain high. New York city reportedy has an estimate of 20% of the population already exposed to COVID-19 which is a lot but we’re still not quite at herd immunity with the current thought of 60- to 80% depending on what paper you read needed to be at herd immunity.
The other study I want to discuss is the Bradykinin storm hypothesis. We had spoken about oxidative stress and leaky capillaries with the cytokine storm hypothesis and both of these scenerios can be related or occuring concurrently. The researchers actually used the nation’s second fastest supercomputer called The Summit supercomputer and they analyzed 40,000 genes from 17,000 genetic samples of covid-19 and the researchers found that there was a large expression of genes that were represented from the renin-angiotensin system (RAS system) . Bradykinin, which is the key peptide, causes blood vessels to leak, allowing fluid to accumulate in organs and tissue. In COVID-19 patients, this system was unbalanced. When the system is in balance then you get a lot of talent that can accumulate a free sample in the lungs so with SARS COV-2 or COVID-19 the entry point is through the ACE2 receptors initially in the nose, then to the lungs it causes the rest of the body to what we call upregulate ACE 2 receptors so that the virus can get into other areas such as the intestines, kidneys and heart. This is much like a burglar that turns gets into the house via an open second floor window in and then once it gets in it starts to disable the alarm systems or whatever you have for security in your house ; all the bolts in the front door and the back door are unlocked allowing for virus to enter. Once in cells, the virus replicates itself or hijacks the cellular machinery to make more of itself and increase the number of ACE2 receptors allowing more viruses to get through. So cells are infected and just as important is that many more cells express the ACE2 receptor which can result in a bradykinin “storm situation.” Normally Angiotensin convertin enzyme (ACE) breaks down bradykinin but this system just gets whelmed and that's why you get all these symptoms and like I mentioned. There's a cytokine storm system as well which is oxidative stress from viral damage and lead to damage of the capillaries we talked about before and these two systems combine to wreak havoc. So this bradykinin system causes weakness of the blood vessels which we see and results in fluid accumulation in the lungs the worst thing is that not only do you have the fluid accumulation you have something called hyaluronic acid that is produced in the lungs. It's been this production of hyaluronic acid, used in soaps and lotions , because it holds onto water absorbing a lot of liquid so if it's good for lathering and making soap but it also causes some problems when you try to aerate or try to get air and oxygen into the bronchioles and capillaries in the lung.
It makes the water like a gel or almost like a Jello so that's why there was problems with ventilators in that is trying to push air through and you're trying to almost breathe the water in the lungs which quickly becomes almost like a gelatinous Jello consistency and that's why using the ventilators have not been very successful.
The bradykinin hypothesis also explains why about 20% of COVID-19 patients have heart damage, because RAS controls aspects of cardiac contractions and blood pressure. It also supports COVID-19’s neurological effects, such as dizziness, seizures, delirium and stroke, which is seen in as much as 50% of hospitalized patients.
In people that have this Bradykinin storm, the best option is to recapture or get better control of the renin-angiotensin system especially before they require a ventilator. Vitamin D is very interesting because it also is involved in the renin angiotensin system. I told you about vitamin D being a potent antioxidant in its role in preventing or treating cytokine storm and of the importance of having enough to balance the immune system. I also mentioned that as part of dealing with Covid-19 is all about prevention and vitamin D seems to play multiple roles whether you favor the cytokine storm hypothesis or the Bradykinin storm but they probably both work together to cause respiratory, heart, and kidney failure. Vitamin D is not only an antioxidant but it helps reduce levels of the REN gene that makes the renin which is the part of the renin-angiotensin system. So this effect from Vitamin D on the REN gene helps downregulate the uncontrolled a bradykinin storm. So once again, Vitamin D has a multiple important roles in the prevention and possible management of the complications of COVID-19 whether from a bradykinin or cytokine storm.
If you have comments, questions, or want to learn how functional medicine can help with improving your gut, maintaining brain health, and optimizing immune function call our office at (925) 736-9828 or email email@example.com.
For more information on supplements to boost your immune system click on this link, call our office at (925) 736-9828, or email firstname.lastname@example.org.
Take Care and Stay Healthy.
Jeffrey Mark, M.D.
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