Right now, the US has declared a state of emergency over the COVID-19 pandemic.  Many people are growing concerned as it spreads closer to their local communities and hear about people needing to be hospitalized for severe cases.

Coronaviruses do not magically “jump through the air” and enter your body. Viruses cannot enter your body through intact skin.  Essentially, respiratory viruses enters from 4 openings in the body:  2 Eyes, 1 Nose, and 1 Mouth.  We need to make sure we are protecting these like a goalkeeper in a soccer game.  First, we need to learn to keep our hands away from our faces.  If you pick your nose, rub your eyes, adjust your eyeglasses, touch your chin, or scratch your face, please stop these right now.  You may want to consider wearing glasses (even if you don’t wear them normally) as it can prevent you from rubbing your eyes.  Wearing makeup also prevents you from touching your face. Use a headset to speak on the phone so your phone doesn’t brush up against your cheek.

How about wearing a mask?  If you do not have symptoms of cough, a mask is not likely to protect you in public.  Healthcare workers wear them because they are at high risk of getting coughed or sneezed on.  I was on the subway today and someone was wearing a mask and got a phone call, she proceeded to pull down the mask and have her conversation and replace it afterwards.  In essence, by wearing the mask, she touched her face twice.  Had she not worn a mask, she would not have had to touch her face.  Ironic that something she thought would protect her, actually increased her chances of getting sick!

Right now, we all need to be strengthening our immune system.  I tell people, imagine you are an Olympic athlete (how appropriate since this is the year of the Olympics!) and the big game is tomorrow.  I’m sure you wouldn’t be drinking martinis or eating McDonald’s the night before.  We should be extremely disciplined with our lifestyle.  Get adequate sleep, avoid alcohol, get regular exercise, get sun exposure (vitamin D can improve immune function, NOT vitamin C), eat plenty of fruits and vegetables, avoid overly processed and fast foods, drink plenty of water (your urine should be clear and almost colorless), meditate, reduce stress, get fresh air when the weather is good, shower regularly, moisturize your face and nostrils with facial moisturizer every day, and make sure the humidity is correct in your home.  Ginger tea has been used in China to boost immune function.  It also is obvious we should not be smoking or vaping as these already negatively affect the lungs.  Most importantly, WASH YOUR HANDS!

As you may have heard, we are having a global health crisis caused by a virus known as COVID-19.  This virus in the Corona-virus family is thought to be spread by human to human contact, mainly from respiratory droplets and possibly also from urine and feces.  The main routes of entry into our body is through our mouth, nose, and eyes.

Here are some steps that you can take to protect yourself from infections during this time:

• Wash your hands!  Make sure you wash with soap and warm water.  The proper duration of an effective hand cleaning is about the time it takes to sing the “Happy Birthday” song twice.  This so so important, especially before eating or touching your face.
• Limit unnecessary bodily contact with other people.  In times like these, we should be reducing kissing/hugging/handshakes as these can easily transmit viruses.  Try other forms of greeting such as bowing, “namaste” with hands together, and waving.  I recommend placing hand sanitizers in by the doorway in your home, to remind yourself to use it after you entering.
• Avoid touching things that many other people have touched with your bare hands.  If you do, wash your hands or use hand sanitizer afterwards.  Door knobs, restaurant menus, toilet flushers, subway poles, airline arm rests/tray tables/seat belt buckles, and pens at banks are some examples.
• Get adequate rest each night.  Your immune system needs adequate rest to be strong enough.  Here are ways to get better sleep.  If you need discipline, set up your phone alarm to ring at a certain time each night.  When the alarm rings, all electronic devices and lights must be turned off and you must get ready to go to bed.
• If you are flying on an airplane, here are tips to stay healthy.
• Get your flu shot if you have not gotten one this season (after Sept 2019).  No, it’s not too late!  We are still at the tail end of a very bad flu season.  Flu symptoms and COVID-19 are almost identical.  If you get the flu, you may panic and think you have COVD-19.  Also, the flu could worsen your immune system and make you more likely infected by other germs afterwards.
• If you are over 65, get your pneumonia shots (Prevnar-13 and Pneumovax 23).
• Eat a balanced diet with plenty of different colored fruits and vegetables.  Each color represents a different vitamin.
• Exercise regularly, in moderation.  Exercise can mobilize white blood cells, which are like policemen in the body, to different parts of the body.  Don’t over-stress your body with intense workouts as that could actually reduce your immune function.
• Prioritize sleep.  This is so important!  Sleep is really one of the most important ways our immune system gets stronger.
• Avoid extreme dieting/excessive weight loss.  I am a big proponent of trying to reach your goal BMI, however this is not the right time to be losing too much weight.  If you do get infected with COVID-19 and you have fevers and loss of appetite you will likely lose weight and that could be harmful if your weight is already on the lighter side.
• Don’t smoke or vape.  All respiratory illnesses are worsened with any type of inflammation caused by these chemicals in the lungs.
• Avoid touching your face with unclean hands.  If you feel an itch that you must scratch on your face, use a clean tissue.
• Stay hydrated and moisturize.  When your nasal passages dry out, it can cause cracking and irritation which allows viruses into our body.  Just as you would apply lip balm to your lips in the winter, put a tiny amount of vaseline around your nostrils to keep them moist.
• Reduce stress, meditate.  When your body is stressed out, the immune system function is reduced.  Try to do some meditation, and take your mind away from fearful thoughts.  Avoid watching or reading too much of the news stories, as some of them can be false or paint the worse case scenario.
• Laugh, interact with friends and family (perhaps virtually, depending on the recommendations about acceptable distance at the time you read this).  A positive outlook can certainly improve immune function.
• Wear glasses.  If you normally wear contacts, change to glasses.  If you don’t wear glasses, consider using a “blank” set of glasses. Ideally the larger the frame size, the better.  The eyes are a way for germs to enter our body, by having a barrier, you can reduce droplets from getting in contact with your eye.  Also, wearing glasses can be a reminder not to rub your eyes or touch your face.
• Postpone elective surgeries, avoid going to medical offices if not absolutely necessary.  Many doctors offices now have the capability to do “virtual video visits” where you can speak with you health care provider over video chat.  You really don’t want to be sitting in a waiting room with many other sick people right now.  Be sure not to touch the waiting room magazines!
• Make sure your chronic medical conditions are under control.  For example, if you have diabetes, make sure your sugar levels are controlled.  If you have high blood pressure, make sure you are monitoring your blood pressure closely at home.  If not, you may need to adjust your medications or diet.  Check in with your medical provider (ideally through a virtual video visit and not in-person), and ask to review your conditions, medications, and symptoms.
• If the weather is nice, plan gatherings outdoors.   Open spaces are not conducive for viruses to spread from person to person.  The wind current would disperse particles far and wide.  If you must gather indoors, open the windows to allow for fresh air to circulate.  Avoid gathering in tight spaces.  The recommended distance for ideal protection is a six foot radius.  For social events, consider patios, terraces, or backyards.
• Take Vitamin D3 1000 IU’s per day.  Some studies have shown a correlation between low levels of Vitamin D and reduced immune function.  Vitamin D is usually activated by our body from sun exposure.  During the cold and dark winter months, we are more likely to get sick with the flu and cold viruses because of this.  If you do have a sunny day, go for a walk for at least 10 minutes, that is another way to get adequate Vitamin D.
• Do not take Vitamin C.  There has been no benefit shown for this vitamin in relation to preventing colds/flus.  In fact, taking excessive Vitamin C can cause kidney stones and other health issues such as heartburn and stomach ulcers.
• Humidify your home.  Dry air leads to skin and nose irritation.  Here are ways to get more moisture in your home.
• Moisturize your face, especially your nasal passages and skin on your face.  When your skin gets dry, it cracks and creates openings for viruses to enter.  Use a warm moist towel to add extra moisture to your skin.
• Make ginger tea and drink daily.  In traditional Chinese medicine, ginger boosts “Yang” energy which can improve immune functioning during winter months.  Simmering ginger tea on the stove will also add humidity to your home.
• Hydrate, hydrate, hydrate!  Drink enough water/tea/soup.  Your urine should be clear and almost colorless. If it is apple juice or tea colored, you are not well hydrated.
• Wipe down your electronic devices regularly.  Our phones and tablets can be quite filthy considering how many times we handle them each day and lay them down on all surfaces.  Keep a bottle of glass cleaner spray and paper towels on the counter and remember to clean your devices.
• Wash your clothes after coming in from outside.  This is more important for shirts as your sleeves are more likely to get contaminated compared to your pants.
• Clean your phone.  We often forget that we touch our phone so many times in a day.
• Don’t panic!  Anxiety worsens our immune system function.  Just use your common sense.  Do not let the fear of the virus overwhelm you or make you feel isolated.  Use other forms of electronic communication to stay in touch with loved ones.  Try to continue doing things you normally would, with just a few extra precautions.

Over the next few months, Americans will be traveling for the holidays.  Unfortunately, this travel time will also coincide with the peak of the cold and flu season.  During the holidays, we tend to gather indoors in homes that are sealed up, which allows germs to spread quicker than if the activities were outdoors.  Here are some tips that can prevent you and your loved ones from getting sick on airplanes.

• Get your flu shot (if you haven’t already).  Getting the flu can be devastating, but fortunately, the flu shot provides some protection and can shorten the duration and severity of symptoms.  You should get your flu shot as early as October, but no earlier.  It takes about 2 weeks for the flu shot to be maximally effective, so be sure to get it at least 2 weeks before Thanksgiving.
• Get adequate rest.  The holidays can be a stressful time with chores, shopping, cooking, and traveling.  Make sure you allow your body to rest.  Your immune system will work the best if you do.
• Avoid drinking alcohol on the plane.  Even moderate amounts of alcohol reduces your immune system significantly.  Alcohol also worsens jet lag, and in some people the effect of high altitude enhances alcohol, i.e. you can get drunker faster with lower amounts.  Here are other negative effects of alcohol.
• Wipe down your seating area, tray table, television screen, remote control, arm rests, and seatbelt buckle.  These are usually not cleaned between flights, so they have the potential of harboring several passengers’ worth of germs.  I recommend WetOnes antibacterial wipes as they are TSA approved for carry-ons.  Antibacterial gels are still considered liquids and can’t really remove dirt without a cloth.
• After using the toilet, wash your hands, dry them, then use the WetOnes antibacterial wipes to clean your hands after you return to your seat.  Having been on many airplanes with tiny bathrooms, it’s almost impossible to avoid touching the lock or doorknob.
• Avoid drinking coffee or tea on the plane.  The “hot” water in planes usually runs through old pipes which have been found to harbor bacteria.  Furthermore, the water doesn’t reach boiling temperature long enough to kill them.  Ask for bottled water, seltzer, or juices instead.
• Open the air vent above your seat and point it so it is aimed just in front of your face.  Many studies have found that the air in vents is relatively germ free as the air filtration system is usually decent.  By aiming the air away from your face, you create a current of air that can deflect germs.  Imagine if someone sneezed near you, releasing millions of fine germ particles into the air.  By having the air blown away from you, these droplets would be deflected away from your face and body, reducing your chance of breathing in the droplets.
• Use antibacterial wipes on your hands just before you are ready to eat.  Even touching the menu or magazines just before you eat can contaminate your hands.  Germs need to enter our body through our nasal passages or our mouth.  Each time we touch something and then our face/mouth/food, is a potential risk for infection.
• Avoid raw vegetables or meat on flights originating in countries where you cannot drink the water.  Many travelers assume that when food is served in plastic containers they are somehow made “sterile”.  In my experience, I have seen many travelers avoid certain foods, only to eat them on the plane resulting in severe illness.  Save the raw vegetables or meat for when you return home.  Typically, flights that originate in the US should be ok.
• Opt for seats away from the aisle.  Many people walk down the narrow aisles constantly.  One or two people coughing while walking down the aisles can spread tiny droplets onto the heads of people sitting along the aisle.
• If you are sick, cough into your elbow, not your hands.  Here are some tips for traveling while sick.
• Exercise regularly before and after your flight.  Regular workouts can boost your immune system and can also reduce your risk of deep vein thrombosis (DVT) which is a life threatening blood clot.  Here are ways to get exercise on your vacation.

Today, the New York Times published an article, “Eat less red meat, scientists said.  Now some believe that was bad advice”  The article, which cites a meta-analysis (compiling and interpretation) of other studies published this week in the Annals of Internal Medicine, mainly states that red meat does not cause a significant increase in heart disease and cancer as once thought.

This does not make logical sense.  We know ingestion of red meat, which is naturally high in saturated fats, increases LDL (“bad” type cholesterol) which in turn raises the risk for heart disease, high blood pressure and stroke. In addition, meats are very calorie dense when compared to vegetables.  So even eating the typical four or more servings that most Americans eat every week is likely to be too much.  We cannot deny that there is an obesity epidemic in the US right now.  Over 1 in 3 people have a BMI over 30 (clinically obese) and the incidence of childhood obesity is growing.  We all know that obesity leads to diabetes, high blood pressure and high cholesterol, all three of which contribute to a much higher risk of heart disease.  Given this setting, it is inconceivable that a medical journal with intentions of promoting health and wellness would consider putting out misinformation that could jeopardize the health and wellbeing of millions.

The decision to adopt a healthy lifestyle is never easy and involves a ton of education, determination and commitment.  The article published in the Annals will reduce the credibility of decades of obesity research and recommendations of the medical field.  I fear this will lead to a mistrust of tried and true diets such as the Mediterranean diet, which can reduce both heart disease and diabetes.

How should you eat in response to these findings?  If you choose to eat red meat, moderation is the still key.  Choose leaner cuts of meat with less white “marbling” which is fat.  The recommended serving is a piece of meat no larger than a deck of cards or palm of your hand per meal.  If you aren’t eating meat, I wouldn’t encourage you to start.  The study didn’t find that there was anything wrong with a plant-based diet.  I would still avoid concentrated sweets, sugary beverages, overly processed foods where the nutrition labels read like a list of chemicals, and refined carbohydrates.  Fruits, vegetables, whole grains such as faro and oats, and seeds such as quinoa should still make up most of your diet.

We all must decide for ourselves what foods are good for us.  Think about how you feel after eating certain foods.  Ask yourself, “do I feel sluggish, tired or energetic and alive?”.  Are you gaining weight from eating too much?  Maybe cutting out the meat will help, I encourage you to make the decision for yourself and trust your judgement.  If you are not sure, have your cholesterol checked and have a conversation with your doctor.

The CDC recently reported an alarming increase in vaping-related health issues and recommended that people stop using these devices.  Across the nation, people who vape are presenting to health care facilities with respiratory issues that resemble pneumonia (lung infections) caused by bacteria or viruses, but neither of these are found in their lungs.  There is some speculation that the users have either altered the liquid that goes into the devices or the manufacturers of vaping fluid have added newer chemicals which have made them more toxic to the lungs.

As I have mentioned in a previous blog, vaping is not a safe replacement for tobacco.  The “vapor”, which is actually a misnomer because there is no water vapor in the white clouds inhaled by users, is actually propylene glycol, which is a toxic chemical known to cause seizures in humans.  In fact, many emergency rooms across the US are seeing people with no prior history of seizures present with seizures from excessive vaping.  By the way, propylene glycol is often used in rock concerts or dance clubs to create “smoke” effects.  This chemical does not belong in our lungs and while there is no long term data, as we know from related chemicals in the lung such as nicotine, carbon monoxide, or asbestos, our lungs cannot handle foreign chemicals very well.  It won’t be long until we find propylene glycol or one of the other 20+ chemicals in vaping fluid causes cancer.

If you, a friend, or loved one is vaping, please urge them to stop.  Vaping should not be a replacement for cigarettes.  If you need nicotine replacement or medications to stop smoking, contact your health care provider and they can provide safer and more effective treatments.