Part 2: Dr. Cook Podcast chat with Dr. Helen Messier

 We know that vitamin A, vitamin D is zinc. Those are really important nutrients for immune support. People that are low in vitamin D are more susceptible to getting other types of infections. We have zero evidence right now that they work for Covid-19.

Welcome to the Biore Reset Podcast. This is my friend Dr. Helen Messier. It's Friday, thank God. And uh, we are both, uh, drinking tea. We are drinking tea. We're comparing what our cups say. Compare What is your cup? I think, I think dot, dot, dot. Oh, that's a good one. In 1837, mine says, life is sometimes not to risk more dangerous than adventure.

It's like some kind of English interpretation of a Chinese proverb. I love it. But, um, so that's maybe a great place to start because we're trying to figure out what to do and we're trying to, we're we're talking about risks and how to manage this chaotic situation. How to, how to understand research. And I think Helen is a great voice in, in helping to talk us.

Talk us through that. Um, do, just from the research perspective, we were talking about that and peer reviewed research and, and how as physicians we. We contextualize and interpret research. Do you have any thoughts you'd like to share about that? Yeah, so I think that's a really good question and um, you know, in light of all of the papers that are being published right now around covid, I think we really have to look at how research is done, what it means.

You know, like I said, we could talk for hours just on research and how it's done, uh, alone. But in general, if we look at before the pandemic, how was research done before the pandemic? It was done where, you know, scientists, physicians, they would either do, uh, research in the lab or. Clinical research, uh, we would cap, they would capture the results.

They would write it up into a paper, and then that paper is submitted to a journal. Now, when the journal gets it, they take the paper and they disseminate it out to other experts in the field. So that's what we call peer review. So that peer review process, these other experts look at, they read the paper, they, you know, punch holes in any lo logic flaws, in any methodology flaws, um, and ask for clarifications, potentially ask for more, uh, data to be supplied.

That's really the sound robust peer review process. Once that paper has passed the peer review process, then it's published in, in the journal, whatever journal that is. So usually when we see papers published, we can, you know, count on, you know, at least it's, it's gone through a, at least a. Some due diligence, right?

To show that, you know, the findings are fairly sound and other experts in the field think that this is suitable for publication. What's happening now, because we're in the midst of this pandemic, we have this crazy amount of need for information and this need for research, and a lot of those rules have been, uh, kind of lightened up on, uh, you know, we're doing a lot of research very fast and we're putting them in what we call pre-publication.

So these are pre preprints. They actually are being published online before, um, they've gone through that peer review process. And what's happening is that, you know, the press, other people are seeing these, they're picking them up and they're reporting on them. So it could be a study with very, you know, poor methodology, a terrible study.

Yet that gets taken as, oh, this study said this. And so I think that's happened a number of times already in, in different medications that are being used to, you know, possibly treat, uh, covid. And, and then, you know, I wanna also, I. Kind of fill in and step back from that and say, you know, what's the type of studies, you know, there was a really beautiful study that, again, put in pre-print on online, uh, looking at, um, what we call in silico data.

So it's, it's kind of in silico is just kind of in the computer, right? Let's look at what we know about the human interact and the virus interact, and how do they connect to each other. Are there any, uh, places or drugs or supplements that we see could fit and interfere between the virus and the human?

And, you know, some, and that's like using AI right? To Yeah, exactly. It's, it's using ai and so we call it kind of silico, uh, evidence. Now that's, Awesome and it needs to be done, but it's really all about generating hypotheses that then need to be looked at in more in depth. You can't just use that kind of data and say, yes, everybody should be on this particular drug if it's found in that kind of study.

Another kind of study that we see a lot of are in vitro studies. So studies that are done in, in vitro essentially means outside the body in the test tube. So, you know, you're looking at, uh, models of, you know, lung epithelium. In, you know, you grow models of like the tissue culture and you grow it in a Petri dish and then you add different things and see what happens to that.

Or you add a virus and then see what might inhibit that virus in vitro. Okay? So that's very different once again than actually using that substance in the body. So it's another step in the process of discovering if that is a good substance to use. Um, and, but you can't take it at face value. You know, taking something, adding it to a, a Petri dish is, has a very different effect than if you swallow it and it, you know, gets, uh, used in your body with all of the other things that happen in a human body.

Another type of testing and that's done is in animals, right? So we are, we're familiar with rats and mice. Again, another important step in understanding things. But rats and mice are not humans. And so even though we get a lot of insight in animal studies, oftentimes, and it's happened time and time again, where we find something in an animal, get very excited about it, and we try it in a human and it just doesn't work the same.

So, you know, we're very different, uh, from mice. And so, and then we get to the human clinical trials and there's a lot of things you have to look at in terms of how the methodology was done. Was it observational? Was it a randomized trial? Was it a blinded trial? How many people were in it? Did they appropriately track the endpoints?

So there's a lot of, um, you know, definitely a lot of different ways of doing human research and not, again, not all human research is the same. So it's very complex. And, and now when I think the world is looking on anything that's published on covid, I think a lot of people don't understand or all of the differences between the different types of research.

Okay. That's a good one. So then that's our framework today, that we are gonna start to then have some conversations about some of the mm-hmm. Issues that are going on and know we've got all of these different levels of evidence. Mm-hmm. And so then we have to try to, and, and so what we're basically faced with is trying to make judgment calls about what to do.

Right from very different levels of evidence and then trying to put that together and interpret it. Exactly. And that that's exactly what we're facing. And you know, we are in a very high need. We need to use something. And so sometimes in these cases we use information from say, lower levels of evidence because it's worth a try.

So that brings up the other concept that we use in medicine a lot is what's the risk and what's the benefit of trying something. Now if it's uh, a very potentially high benefit, meaning someone's in the I C U and they're going to die unless we try something, then we're going to be a lot more lax in terms of what kind of things we'll try.

They might not have sound evidence around them, but we're gonna try it anyway cuz we wanna save that person's life. Right? And now then the same idea is what are the risks of that? Uh, so now you have a healthy person. And they might have a few symptoms, but they don't have any underlying health conditions.

And, um, you want, you know, they get, they get the symptoms, but you wanna prevent them from going on to get a further, you know, end up in the ICU u you don't want them to die. Are you going to use that same drug that you might have used in the ICU to save someone's life with someone that's healthy, that could potentially cause a lot of harm.

Okay. And, and I think everything we do has to be a balance of what's the potential risk and the potential benefit. Okay. I got, I have a good one. You're gonna love this. So, so then what? So it's so great because today I did a podcast with my good friend Matt Dawson Uhhuh. And so he, he has a practice that's kind of similar to ours and, um, Uh, we all kind of have to some extent, a little bit of a concierge practice that is wellness based and probably we've all seen some of the same people, uh, for sure, a hundred percent.

We've all seen same, same people. And so we have, he's, he like you, is also interested in genomics. And I can say that Helen's one of the smartest genomics people probably out there. And, and tell, tell people a little bit about your experience with, uh, with Craig Benner and what you did there. Yeah. I, um, worked at, uh, human Longevity, uh, Inc.

Which is a company that was founded by, uh, Craig Benter was one of the founders. He is, uh, for those of you who don't know, Craig is well known in the scientific world as the person who first sequenced the human genome. And so I had a, a very privileged, I had the opportunity to work at h l I, you know, under the leadership of Craig.

And, um, and not just Craig, but I worked with, I think, some of the brightest minds in the biological genetics world. I was very, very privileged to be able to collaborate and work with, with all the people. And obviously, you know, when we all get together, there's a lot to be learned from each other. Okay, great.

So then my friend Matt, uh, is an ER doc Uhhuh, and so he is in a small town in Kentucky. And so basically all the er docs that work and pick up the ER shifts are older guys and a bunch of 'em are immunocompromised. And so basically nobody's agreeing to work. And so he has 20 shifts next month that he has to work.

Wow. Just because in his community. Yeah. And so then we, it's worth a listen for people, but then what, and I, I, we had this real procedural podcast because he told me a story about a woman who was coding and he ran in and he couldn't mask ventilate her because if he did the mask ventilation will spread viral particles to everybody in the room.

And so he ran in and did a video laryngoscopy and intubated this woman. And saved her life. Wow. And so then what I'm gonna do is I'm gonna compare and contrast cuz that we, we, it was really a procedural, how do you manage the logistics? Yeah. And so then it's gonna be interesting because, so every day, for the next month and at least for 20 days, and some of these are 24 hour shifts, he's gonna be continuously exposed to people who are positive Right.

And then intubating 'em and there's probably no higher risk Right. Exposure than intubating somebody who's got mass amounts of virus. Absolutely. And so then we, um, and so then what I'm gonna compare, and, and so I said there's kind of two conversations. There's this, what do you do at the moment? Like he was making a judgment call, do I mask, ventilator or not?

Based on who's in the room. And then were, he also had to make a judgment call. Do I take some kind of form of prophylaxis? Like a supplement or like hydroxychloroquine or do I not? And so then we kind of talked about that. And so then what I'm gonna do is I'm gonna launch, well just go, let's go ahead and launch into the hydroxychloroquine conversation because this is a drug, uh, a pre-publication came out suggesting that it was good.

And ta tell us about that research because I think it's interesting to hear kind of the peer reviewed academic kind of take on it. And then we're gonna compare and contrast that to a guy running around the hospital intubating people that are Yeah. Loaded with virus in their lungs and trying to decide what to do.

Yeah. And if we, uh, can we do screen sharing on here? I would love to, um, show sort of some of the critiques of that paper. So I think the paper that you're referring to, um, and I may not get it up in time, uh, but the paper you're referring to is one where they, uh, took, uh, patients coming in, uh, to an ice, to a, to a hospital.

And they either gave them, you know, hydroxychloroquine, hydroxychloroquine and azithromycin or, um, a control group that didn't get that. Mm-hmm. And um, the outcome of that was looking at viral load in a throat swab. And, and so, you know, how did the treatment actually reduce the viral load in the throat swab?

So, you know, you could right off the bat, um, argue is that the right outcome to be looking at the amount of viral load in a throat swab. You know, it does. And cuz we don't necessarily know whether that viral load actually has anything to do with overall outcome, you know? So that I think in and of itself is something that we, we can argue with.

But if you give the, sort of called the secondary endpoint, right? So we're looking at viral load rather than, you know, did they die? Did they get better? That's sort of the more relevant outcome. And, um, they ended up, uh, basically the paper published saying that it, the, the treatment of hydroxychloroquine and azithromycin reduced overall viral load at a certain day and I can't remember the exact day six or day seven after treatment.

And, um, that was, you know, a big, uh, A lot of social media picked up on that. A lot of, uh, people said, let's use hydroxychloroquine azithromycin based on that study. Now some of the problems with it are, you know, sure. They used low numbers of people. I think 26 were registered in the treatment arm. Um, the control arm was actually recruited from some people in a different hospital.

So some in the same, some in a different, so right then, and there was treatment different in that other hospital. So now you can't compare apples to apples anymore. We're now comparing, in a way, apples to oranges. And um, and then what happened is a number of people. Uh, they couldn't follow up for those people.

They couldn't get the final, um, swab for the viral load because they were taken out of the study. And if you read why a couple were transferred to the I C U, one of them died and, and they ended up not including those people that were in the treatment arm in the results of the study. Now, clearly if they did, it would make the treatment not look not nearly as good If, you know, three people, you know, people ended up in the ICU because they, you know, they were on that treatment arm.

So that's just some of the sort of controversy around that particular study and, you know, It's currently kind of going through peer review now, because a lot of people are commenting on it, which is the process that's supposed to happen, right? This is the idea that allow other scientists, other researchers, other physicians to comment on it, punch holes in it and, and cease.

But what's happened is it ended up getting spread to the world before that could happen. Right? So then, but then even now it's kind of interesting because here, here we are and, and so we may be punching holes, but there may be still some benefit to it, right? Yes. I'm not saying So we're punching holes in the study.

That's correct. We're not saying just because there was problems with the study, uh, also doesn't mean that there may not be benefit. That's exactly right. Exactly. And so it's uh, it's like the most interesting moment. To me of our career because mm-hmm. Now we're at this. Interesting, it's like peer review real time.

Yes. It's like it goes out and then obviously cost to run on the hydroxychloroquine market. So you can't even, you can't even get a prescription for it if you wanted to. Right. That's right. Um, and which is a problem even, and you might be on lupus, have lupus or rheumatoid arthritis, and you might be taking that medication, you can't get it.

So that's a, it'd be interesting kind of comment. Mm-hmm. Um, which is unfortunate. Um, and, uh, and so it's, it's, and so, and, and we are gonna, we are gonna play this forward, but it was interesting because my friend, you know, India, I was telling you on the phone before we talked, India is actually giving hydroxychloroquine to every healthcare worker who's, uh, dealing with this.

And so my friend Matt, today, we talked on the phone. One of his best friends is the ER doctor in New York who's pregnant. Yeah. And she tested positive. So then, and I think that probably most of the ER docs and most of the anesthesiologists in the country are gonna end up testing positive for this probably.

And so it's interesting then to, to take that back. Now you have these people out on the front lines that are in between a rock and a hard place. The science isn't perfect. Mm-hmm. We're punching holes, but we're trying to also understand, we're trying to help them, right. Make their judgment calls. And then it was interesting because, you know, this is a, because this jumped from animals, our immunity is not as good as a normal flu.

Right. And so it was his conversation and I just, I loved the attitude, but it was almost a little overwhelming to hear because. The attitude of the ER doctors is kind of like, well, if you get sick, just hope that you'll get better in a week or two. And then that you can go back to the front lines and then release all the people who are getting sick.

Right. And then hope that you have a month or two of immunity. Mm-hmm. Which is kind of like a crazy thing to say. It was just, it was just like, I've been kind of overwhelmed by that idea all day. And then he said, and, and this was, and it's just interesting to think of different specialties. Mm-hmm. Because then he's like, but then what's gonna happen is everyone in the ER is gonna be positive.

And so then we're gonna go to, just go to, we're just, it doesn't ma cuz right now the idea is don't go if you're positive. Mm-hmm. Cuz you're gonna infect everybody there. Right. Then pretty soon what's gonna happen is everybody's gonna be positive. Right. And so then all the doctors are gonna be positive and they're gonna be, they're just gonna go to work anyways because there's people coding in hospitals and there's not gonna be, I read a post of an anesthesiologist that had said that he had worked 5 24 hour shifts in a row.

Wow. And that's just so, yeah. That's crazy. That's crazy. And, you know, that's, I, I can un totally understand that attitude. And part of it is, you know, other countries, for example, have created dedicated C hospitals. That everybody in that hospital is positive so that you don't have to do that same, oh, I'm going to, you know, we have to protect the other patients from getting it, you know, everybody in that hospital and, and you keep non covid patients for all of the other things in different places.

So that's, you know, one way to address that. We're not currently doing that in most of our hospitals right now. Um, but, you know, doing 5 24 hour shifts, there's no better way to make yourself more susceptible, as we talked about earlier. I know, I know. I don't know this person. Barb. Barb just showed it to me.

Yeah. You know, lack of sleep makes you much more susceptible to, um, sick. I know. Sick. And it's, uh, yeah, unfortunate that our healthcare workers are being put in that situation in the first place. Now, now I proposed, I gave you a little case study and it was just a made up case, but I said, okay, I have a 50 year old woman in.

In Santa Clara County, that's where we are. Right? Mm-hmm. Which is, and let's say she got a sore throat and a fever, and she is worried that she's got covid. So then what does she do to get tested? And then how do we manage her? Like if I gave you that case and we can spin it around. So, uh, uh, yeah. Yeah. What would, what would you, and, and you told me a great anecdote about a friend of yours.

That's right. Yeah. The, so, you know, the testing is still not very readily available for, you know, to test anyone who wants to get tested. We're still at a point where you have to meet certain criteria in order to get tested. So healthcare workers clearly are on the higher on the list in order to get tested, cuz we wanna know if they're at risk and gonna spread it.

Um, uh, if you have an underlying condition, uh, you know, like we talked about last time, high blood pressure, cardiovascular disease, diabetes, the high risk people, um, are more likely to get tested or they should be tested. And then, and then there's everybody else. Like, you know, so my question is this case, this 50 year old woman, would, you know, does she have any underlying conditions?

Right? Does she have high blood pressure? Does she have diabetes? That, so the answer always, as we talked about before, is it depends, right? Yeah. I gotta get the context. It depends. I have one, I'll wear it next time. I, okay. Yeah. So we have to, you know, understand the context and, you know, my feeling is if there was enough tests, everybody should be tested because that's the best way that we can trace what's going on and actually be able to control, um, the virus and the spread of the virus is by, is by testing everyone and seeing what it's doing.

Mm-hmm. Unfortunately not at that. We don't have the ability to do that right now. So tests are being rationed to the higher risk people, the healthcare workers, the higher risk patients. Mm-hmm. Um, And so, uh, yeah. So what would we do with this lady? You know, I would love to be able to test her. Um, but most times people are told, being told to just quarantine yourself.

Stay home, don't spread it and, you know, monitor your symptoms and if your symptoms got worse, then call someone and, you know, go in the hospital if you have to. It's not a perfect answer, and nothing about what we're going through is good or perfect or easy. Uh, you know, on the other hand, yeah. So that's, that's kind of the testing question.

So to get back to my friend, that's exactly what happened. My friend, um, young, healthy male, uh, he. Came down with very classic covid symptoms of fever, a cough fatigue, but he doesn't have any underlying conditions. He actually reached out to his physician and was kind of sent an email back, said, you know, are you, if, are you in one of these categories, healthcare worker, do you have a chronic condition?

If not, you know, just quarantine yourself and here's how to wash your hands. Here's how to separate from family members. It was really, wasn't overly helpful, at least what I saw. And you know, I think this is the response a lot of people are getting when they, when they get sick right now and they're reaching out and there's nothing, no help for them.

Yeah. Isn't that crazy? It is crazy. Um, okay. You can critique my answer. I'll, you can critique my answer. So now I know of some cases. Mm-hmm. I know some cases of people who were in. Either in hospital or in ICU and deteriorating. Mm-hmm. And someone brought them hydroxychloroquine and azithromycin and I know I, I know of a couple cases where they turned somebody around mm-hmm.

That was circling the drain. That's a kind of a, kind of a house of God type of comment that, that sometimes doctors use that I probably shouldn't use. Um, but, um, so I would like to prescribe hydroxychloroquine, uh, for your friend or for, uh, for our hypothetical 50 year old woman, assuming that they didn't have any risk for QT pro prolongation.

Right. And stuff like that. Right. Uh, that being said, I don't think we have access. So we don't, so we don't have access, so we can't do that. Um, even, yeah. Even if we wanted to, um, I just got messages from pharmacies that I use saying that they will not, they've been told by the fda, uh, that they will not fulfill any, uh, hydroxychloroquine prescriptions unless very specific criteria are met.

You know, are they on lupus? Have they been, you know, do they have lupus? Have they had prescribed before, et cetera. Yeah. So then number two, if either of those people proceeded to develop a pneumonia mm-hmm. I would be interested in giving them azithromycin. Mm-hmm. Um, because I think that that has the potential.

It's interesting and we don't know whether that's an antiviral mech mechanism or whether that's just treating a super infection. Mm-hmm. But I would like to treat them with that. Not to prophylax the pneumonia, but if the pneumonia started to come on mm-hmm. And I don't have, and then it's really good for me to be talking to you, cuz I think my attitude is more procedural.

I come from kind of like my friend Matt, I come from a procedural and you come from a more of a data driven right. Worldview. And so I like, I like that interaction and that, so, so just on that, what, what do you think about my, what I said what, yeah. Do you think, is that totally unreasonable or do you think I don't think it's unreasonable at all.

Um, you know, I think, again, here's the, it depends T-shirt. Yeah. Yeah. You know, it, it's, um, you know, if someone, I would, maybe I would challenge and say if someone's getting pneumonia, which would be associated with shortness of breath and other things, I would really want them monitored in a hospital. You know, um, I think, and that at that point it's very reasonable to use Azithromycin or something like that.

Mm-hmm. Mm-hmm. Or, and or in addition to hydroxychloroquine. Um, so, you know, I think that brings something else we were talking about. Uh, and even a bigger point is that, you know, not only do we need to care for that one individual, which is really what we as doctors have been trained to do, right? Care for that patient in front of us, be that patient's advocate.

And we have to do that very strongly right now. But we're also in the middle of a pandemic where. The rest of the world is going through the same thing and we have to look at scarce resources right now. You know, to the point there's no hydroxychloroquine available because a lot of people have been stashing it.

They've been saving it for just in case it happens, I wanna have someone hand or using it maybe inappropriately. So now there's none left. So we have to look at the risk benefit on the broader kind of community level. Mm-hmm. In addition to the risk benefit for that individual in front of us. And it's not something, I mean obviously in the public health world, that's how they think all the time.

But as physicians sort of looking after individual patients, it's not something we're used to kind of thinking about. Right. We're like, if I decide that this is gonna be the best thing for my patient, I want them to have it. Whereas now we have to go. Which one of my patients do I need to give it to? You know, we have one dose of this or one course of this, who's the best person to get it?

And it's an awful situation to be in, but this is where we are right now. Yeah, I know. It's crazy to to think about like, you know, when you, when you intubate someone, if you ventilate them before your, the probability that it goes better goes up by like an order of magnitude. Right? Right. Cause you're pre oxygenating the lungs.

But my friend had to make a judgment call and not do that cuz he didn't wanna expose everyone else. So it's uh, it's analogous to the public health conversation Exactly. Of trying to take care of like ever think of everybody in the hospital, everybody in the room, everybody in the world. And I think that's kind of cool because.

Most of us never think that way. Most of us are just sitting looking at the person in front of us thinking of that person. Yeah. And I hope this leads to a little bit more connection. Yeah. And a, a more thoughtful, um, experience. Now then let me ask you, here's, here's the next thing that I would do for your friend.

So I'd give oral vitamin C every day. Mm-hmm. Um, I'd give zinc, I'd give some low dose vitamin A, I'd give oral quercetin. Mm-hmm. I'd give some olive leaf extract. I'd give some herbs. Yeah. Uh, and I would try to try to do all of those things to, and, and, and both. And I would give zinc lozenges. Mm-hmm. And then I would, and, and my herbs.

And I would, I would give, um, I would give SBI protect, which is a immunoglobulins or, or colostrum. To try to bind onto any virus that was in the gut because, uh, my sense is, is that a lot of patients are presenting like what we're talking about with these upper respiratory things. Mm-hmm. But it's also in their intestines.

And if we can kind of mop up some of that virus with colostrum or something that was gonna be somewhat protective, that might change the time course of the. Of the illness. Right. Even though I don't have data, that's just how me and you would normally manage a case like that. Right. Right. Yeah. And I think that's a really, really good example of the risk benefit that we were talking about.

You know, we, we know that vitamin A, vitamin D is zinc. Um, those are really kind of important nutrients for immune support. Right. We've seen it. We know that people that are low in vitamin D are more susceptible to getting other types of infections. Those things are, you know, clearly important. We have zero evidence right now that they work for, for Coronavirus or for Covid 19.

Mm-hmm. But, you know, based on, based on our understanding of what happens in other infections, You know, the same thing with the, with the colostrum or using immunoglobulins, uh, in your, you know, orally in your gut. Um, we don't have any evidence that this will work, but, you know, it makes, it makes sense, it makes theoretical sense that it could work.

And what's the risk of taking it pretty low? Right? We, it's, you're probably gonna benefit in some way or another by taking it because these, um, these things have very few side effects if you take them in the right dose. Like if you're not taking mega doses of vitamin A or mega doses of d, you know, in appropriate amounts.

So I, I a hundred percent agree that it's absolutely worth trying because there's very potential for very high benefit and very low risk. Ok. And yet, you know, we don't have the solid evidence supporting them. There's enough evidence out there in other, other situations where they make perfect sense. And, you know, one of the things, and maybe we can get in today or, or later, but trying to track some of that real world outcome data, kind of real world research.

If we can track someone, you know, this my friend, this theoretical, uh, hypothetical 50 year old lady, uh, and have track the course of their disease over time. Uh, and this is one of the things I'm working on. You know, send them a daily questionnaire to, to see how they do. And at the same time we learn, are they taking vitamin D and vitamin A and zinc?

Uh, and now we have thousands of people where we have that information on. We're going to start to see, wow, we know that everybody that's taking vitamin D. They're not ending up in the icu. Right. And maybe there's something that could be really beneficial. So this is also an amazing opportunity to really learn, and we should be doing this real world outcome research, you know, on, on everybody that we can.

Okay. I've got two real world questions for you. And, uh, we know that the, the receptor that this virus attaches to is a receptor called ACE two. Mm-hmm. And, um, it, it turns out that it's related to two very large categories of blood pressure medications. Mm-hmm. And, and so then this is a real world question because we know that, um, people with high blood pressure and some other problems are at highe