How To OPTIMIZE Your Immune System & FIGHT VIRUSES! (Including COVID) | Roger Seheult

1. 0:00 – 2:12

   Inflammation, the Immune System and the Swiss Cheese Model

   1. RSDr. Roger Seheult0:00

      In all of the patients that I am seeing in the intensive care unit that are coming with COVID-19, we're putting them on vitamin D supplementation. It's this mismodulation of the immune system is the reason why people are having problems with COVID-19, and vitamin D is right in the center of that.

   2. RCDr. Rangan Chatterjee0:14

      [upbeat music] You are quadruple board certified. You work in the intensive care unit, seeing patients who are incredibly sick. You're also super passionate about prevention. What are the sort of things that we can all do to reduce the likelihood that we're gonna get sick in the first place?

   3. RSDr. Roger Seheult0:37

      Yeah. So the immune system is a wonderful part of our body, but it's also interactive, and, and a lot of the way your immune system works is through inflammation. There was a, a study recently, they equated that about 50% of all the deaths that have occurred in the United States are due to inflammation. If you think about it, it's actually quite astounding. Uh, heart disease is an inflammatory disease. Cancer can be attributed to inflammation. Um, all of those other, uh, conditions that we talk about are related to inflammation. Sleep affects inflammation. Uh, the immune system uses inflammation. So I, I think when you talk about the immune system, you also have, almost have to step back and, and look at what is going on and the effects of inflammation. That ties into stress. It ties into just wellbeing. It's a huge subject.

   4. RCDr. Rangan Chatterjee1:29

      Yeah. Given how much fear there is at the moment in the general public, I guess all over the world, whether it's here in the UK, with you in America, or, or, or sort of further afield, a lot of people are scared of getting ill, especially coming into autumn and winter, of getting, you know, taken down by viruses. And so I guess are there specific things we can do to support our immune system to help reduce the likelihood of coming down with viruses? So I guess vitamin D, I know you've done a lot of work on this, might be a really good place to start because it's something really practical that we can each do for ourselves, can't we?

2. 2:12 – 8:05

   Why Vitamin D Matters for Immunity and COVID-19

   1. RSDr. Roger Seheult2:12

      Right. So before we get into any specifics of vitamin D, let me tell you what my philosophy is, and it's, uh, it's, it's called the Swiss cheese model. So, um, before anyone gets started on that, you know, sometimes when you talk about one aspect of, of what you can do to prevent, people will get this assumption that you don't need to do anything else, and I am certainly not in that camp. It's, I'm definitely a, a Swiss cheese model. So what is a Swiss cheese model? So any time you cut a piece of cheese, of Swiss cheese, and, and you look at the different pieces, you'll see that the holes are in different parts of the cheese. And if you were to imagine, like, bullets flying at you, and the Swiss cheese could protect you somehow from those bullets except for where the holes are, um, if you just put one layer of Swiss cheese on, you're, you're gonna miss. There's gonna be bullets that go through. A- and the more layers you put on, the better protected you are. So I am definitely an all of the above type thing. So don't, don't, I don't wanna get anyone misunderstanding that just because we're talking about vitamin D, that that's all you have to do, and you don't have to do anything else. Um, as we'll talk about, the more layers of protection you have, the better off you're gonna be. So let's talk, let's talk about vitamin D. I mean, if anybody, if the world has led, if anybody in the world has led the science on vitamin D, it- it's gotta be the British. Uh, it was in the British Medical Journal a couple years ago that there was a, a huge meta-analysis that was published looking at 25 randomized controls, t- trials that showed that, that faithful daily or weekly supplementation with vitamin D reduced the incidence of acute chest infections. Uh, there's a, a study group called Tilda, which is looking in Ireland, and, and they're showing a 50% reduction in acute chest infections, and this was all before COVID-19. So, so what's going on with vitamin D? Okay. So anyone above the 35th parallel, and that for, for those of you living in the United States, that's the southern border of Tennessee. That's pretty low. That's gotta be somewhere, like, around somewhere in Spain. Anyone living a- above that 35th parallel isn't gonna get enough sunlight in the winter season to keep up your vitamin D levels, and so supplementation with vitamin D is gonna be a good idea. I- if you look and see when the viruses come in, when, when the flu virus comes in, when coronaviruses, non-COVID-19 coronaviruses come in, and respiratory syncytial virus, they have this seasonal effect where in the wintertime we have them up in the Northern Hemisphere, and then in the Southern Hemisphere we see them, uh, in July. And so why is that? Well, there's a number of reasons why that could be. There's humidity. Um, there's a number of factors. But we believe that sunlight and direct sunlight with ultraviolet B radiation to the sun produces the vitamin D that we need to be able to modulate our immune systems. So if you look at vitamin D itself, just Google vitamin D, you'll see that the structure of vitamin D looks very similar to steroid hormones like cortisol, like aldosterone, like testosterone. These substances are shaped this way because they can go directly into the nucleus and actually cause transcription of DNA into its effector proteins and change the way cells behave. Now, this is really important when we talk about, for instance, COVID-19, because in COVID-19, there is two parts of your immune system that you've gotta understand. The first part of your immune system is the innate immune system. It starts off early. It's the thing that's responsible for taking care of the virus in the first seven days of an infection. It goes around looking for things that are generally not supposed to be there and eats them up. So macrophages, um, natural killer cells, all of these things are the innate immune system. It's very strong when you're young. It gets weaker as you get older. Now, the second part of your immune system is the adaptive immune system. This is the part that is really causing a lot of the problems later on in COVID when after seven days, all of a sudden the adaptive immune system wakes up, and this is the part that has antibodies, T cells that attack cells where the virus is there. And because the virus has gotten into so many cells, particularly in the lungs, when the adaptive immune system comes online, it starts to attack the lungs, and that's what gets people into the hospital because the lungs become inflamed. They can't diffuse oxygen into the body. And, um, it's this mismodulation of the immune system, some people believe, is the reason why people are having problems with COVID-19, and vitamin D is right in the center of that.

   2. RCDr. Rangan Chatterjee6:49

      Yeah, vitamin D is something that we've, I guess we've known for years helps support our immune system health, and I really like what you said about this Swiss cheese model. I very much have that approach as well as a, as a medical doctor, that y- you know, the nature of science means that we look at one thing in the trial, right? We, we look at does this one thing make a difference?

   3. RSDr. Roger Seheult7:14

      Right.

   4. RCDr. Rangan Chatterjee7:14

      But then when you translate that to a patient, you think, well, there's multiple trials showing that, you know, as we'll talk about today, vitamin D, sleep, stress, these all in isolation have been shown to help support the immune system. So, kind of why do we have to choose one instead of another? Why don't we do all of them? I really appreciate you sharing that Swiss cheese model because I think it's something that we need more of in medicine, if I'm honest, particularly at the moment where, you know, you, you are on the front lines, you're seeing patients with a, with a, with a relatively new set of symptoms. Um, I guess you have to take a common sense approach. You can't wait for all the, kind of, data to be there as you might want. You have to actually go, "Well, it seems reasonable that vitamin D would help support this patient's immune system."

3. 8:05 – 10:32

   Risk and Benefit of Vitamin D: A Practical Approach

   1. RSDr. Roger Seheult8:05

      Yeah, exactly. And, and what's there to lose? I mean, vitamin D is, is probably the most tolerable fat-soluble vitamin there is. Um, very-- there's very good studies that show that, I mean, out of thousands and thousands of patients, the, the risk of overdosing on vitamin D is pretty low. And so when a patient comes in, what's, what's the risk, right? So that's what we do. We treat people. We make sure that they're, um, vitamin D, um, sufficient, and, uh, and we go from there. The, the risks are really low, and the benefits potentially are high. And I know there's a big debate, not only in the United States, but also there in the UK and around the world about, you know, what is the threshold for use of vitamin D? If we don't have direct randomized controlled evidence, um, but we have some case control study data and epidemiological data that's pretty compelling, um, what's the risk really of, of, of, uh, of treating with vitamin D? And I, I, I tend to agree. I mean, we're trying to save, save lives, so...

   2. RCDr. Rangan Chatterjee9:02

      Yeah, I mean, when it comes to vitamin D, um, you know, I'm very passionate about it because when my, my son was six months old, he was super sick. He had a hypocalcemic convulsion when we were on holiday in France, and that was secondary to vitamin D deficiency. So he had, you know, for many months, probably super low vitamin D, uh, that then, uh, led to his serum calcium dropping, which led to a convulsion and us being, you know, super, super scared that we might lose him. Um, so that was really when I saw in a, in a very extreme acute situation just how important this vitamin is. But since then, I've, you know, for 10, 11 years, I've been diving into the research, and you can see associations at least between low vitamin D and all kinds of different conditions. So I personally have a very low threshold to recommend vitamin D to my patients 'cause as you say, I see the benefits potentially are profound and the risks are very, very low.

   3. RSDr. Roger Seheult10:11

      Yeah, exactly. Um, the, the one risk, though, that we, we do is, is those people that don't see the Swiss cheese model. So if they think that just because they're supplementing with vitamin D they're gonna be perfectly healthy, uh, remember that each slice of that Swiss cheese had holes in it. And so you-- it's not where you stop. It's where you start, but it's not where you stop.

4. 10:32 – 15:11

   How Sunlight Makes Vitamin D, Dosing and Optimal Levels

   1. RCDr. Rangan Chatterjee10:32

      What if we-- Just think about vitamin D then. For people listening or people watching and think, "Okay, I get it. It's gonna help me support my immune system," do you have any specific, uh, dosing recommendations I think is important to talk about? But also, I know you're, you're so good at articulating science in a very understandable way. I wonder if you would mind explaining, you know, how we typically would get vitamin D, um, from sunlight, what would happen when it hits the skin? 'Cause I think that's really interesting for people to understand the, the sort of evolutionary context here.

   2. RSDr. Roger Seheult11:04

      Yeah. So there's different types of ultraviolet radiation. There's ultraviolet, uh, A and B, and, um, A unfortunately can get through just about anything, [chuckles] uh, glass as well, um, for the most part, and it causes all the sun damage that we don't like. Ultraviolet B, though, is really what we need to convert the, uh, cholesterol-based substances in our skin into vitamin D. So we-- But the base product is already there. It just needs to be converted using ultraviolet B. That, unfortunately, cannot penetrate through glass, so you really have to be outside with your skin exposed to the sun. And, uh, this happens very, very deep in the skin. And so it, it's so deep, in fact, that people with darker skin, with the melanin in it, will-- it'll actually block that ultraviolet B to some degree. So what does that mean? People who are older are at higher risk for vitamin D deficiency because they don't convert that as efficiently. People who are darker skinned living at higher latitudes, um, are gonna be more, uh, at risk for having vitamin D deficiency. And so that's, that's important to understand. Um, so in terms of the, the basic science, you're getting a cholesterol derivative that your body makes, and you're converting it into vitamin D. So that's the base product. Now what happens is the, the liver and the kidney modify it into its active form, and then it's ready to do its job going into the cells and, and we see vitamin D receptors in not only in bone metabolism, but also in the white blood cells that are especially important in fighting off infections like COVID-19. Now, in terms of dosing, um, the people that are most at risk for vitamin D deficiency, like we just talked about, uh, the, the endocrinological societies recommend, uh, no more than 4,000 units, international units, per day, um, for supplementation. Now, I've seen people personally that have gone up to 10,000 units a day, and, uh, they've had their v- their levels checked, and they were still within a reasonable range that we weren't concerned about toxicity. Uh, you can get 50,000 units, uh, tablets, um, uh, over the counter, and I wouldn't recommend going up that high. But so in terms of what's the highest dose, I would say around 4,000 international units. Uh, people do far less than that. I think, um, the recommendations from the governments are usually around 400 international units a day. The difference may be because we're talking apples and oranges. We have very good data, very good research that goes back decades about exactly how much vitamin D we need for good bone metabolism. But as you know, I mean, just because you need so much flour for one recipe doesn't mean you need exactly the same amount of flour for a different recipe, and what we're talking about here is not bone metabolism. We're talking about immune function, and, um, there are some experts that believe that the levels that we need should be higher. So let's talk about levels for a little bit. Um, there's-- First of all, you have to be careful because there's two different scales that are measured. There's, uh, nanograms per milliliter, um, and then there's nanomoles per deciliter, so you have to be careful about that. The, the nanograms per, um, per milliliter is, uh, usually in the, the 20 to 30 range, um, and that's-- 30 is kind of where you need to be for good bone metabolism. Um, some experts believe you ought to be closer to 50 or even 60, and that's interesting because there was a study in the United States that looked at the incidence of SARS-CoV-2 infection related to vitamin D levels, and they found that as vitamin D levels drop below 50, that's when we started to see an increase in SARS-CoV-2, regardless of where they lived in the United States, h- in the North or in the South, regardless of whether or not they were dark skinned, light skinned, male or female. It seemed to cut across all those different, uh, those different, um, groups. So to review again, um, if you think you're at risk for vitamin D deficiency, spend a lot of time indoors, older, darker skin, high latitude, then supplementation with up to 4,000 international units a day probably would be beneficial, especially if you're not able to get a lot of sunlight and you're going through the winter months.

5. 15:11 – 23:40

   Testing, Food Sources and Evolutionary Arguments About Vitamin D

   1. RCDr. Rangan Chatterjee15:11

      Yeah. There, there's a couple of things there whi- which I found really interesting. First of all, I agree with you. I think we have very conservative recommendations for vitamin D based upon, as you say, the kind of historical nature of study, which has typically been around bone health. And I remember, um, Dr. Seheult, maybe, maybe 10 years ago or so, I was working in a practice in Oldham in the north of England, and there was some new vitamin D guidelines, um, from, from the local health authority that, as physicians, we were meant to be following. And naught to 10 was regarded as deficient. Yes, you should be, um, supplementing and replacing. 10 to 20, I can't remember the exact wording, was something like, um, s- insufficient or suboptimal, consider replacements. Um, and then 20 to 30, optimal, no need for action, which is really interesting 'cause, you know, as you say, we're now talking about potentially, if you're under 50, potentially your immune system health is not as robust as it might otherwise be. So I think this really speaks to something else in medicine which I feel we need to evolve somewhat is, rather than black and white, this is, um, abnormal and this is normal, it's like, well, okay, but what about optimal? What is optimal for what we are looking for? So that was one point I wanted to just, uh, just to raise, which I found really interesting. But then I think the other point is we say for those at risk of vitamin D deficiency, but as you say, some people who take even 4,000 units a day are still gonna be low on their blood levels, and there's all kinds of factors why that might be. I know that there are some genetic variants with the, uh, VDR, uh, receptor that might make it more difficult for those people to, uh, have adequate levels of vitamin D in their bloods. But it, but many of us, we all work indoors these days, uh, talking about the, the Northern Hemisphere. So here in the-- As we have this conversation, at the moment, it is September. You're in America. I'm in the UK. We're at the tail end of the summer. You know, we are now coming into autumn and winter, when actually we're more susceptible to these viruses. So you kinda feel, yes, I've got dark skin, right? So I'm gonna be one of those people who needs much more sunlight to get the same level of vitamin D. But I guess we could start to make a case that, yes, there's people at risk, but it's also-- it's not-- it doesn't take a million-- You know, it doesn't take so many steps on our heads to go, "Well, there's a case potentially that all of us might benefit." Do you know what I mean?

   2. RSDr. Roger Seheult17:58

      Yeah, absolutely. Absolutely. Um, totally. Uh, the-- and, and that's where we are headed in medicine. We're headed to sort of, uh, uh, specialized or medicine recommendations specialized to us individually based on our genetics, based on testing, based on all sorts of things, and, um, this is, this would be no exception. I, I think if someone is really concerned about the potential possibility that they have, uh, vitamin D deficiencies is get tested.

   3. RCDr. Rangan Chatterjee18:24

      I mean, that's-- it's a very simple, cheap test to do. The supplementation is very cheap as well, so I, I think that's a, a really good recommendation. Um, some people say that you don't need to supplement. You can get this sort of stuff from food. I'm not- ... convinced that we can eat enough of the foods, um, that contain vitamin D to actually get those optimal levels. But that's one thing I, I was hoping you might address. The other thing is that on an evolutionary basis, um, some people say, "Well, we're meant to drop our vitamin D levels over the winter, because we wouldn't have been outdoors much." So how does that shape your thinking somewhat if people make those arguments to you?

   4. RSDr. Roger Seheult19:08

      Well, first of all, in terms of dietary, I think, uh, you'd have to eat a lot of mushrooms. I know fish and chips is very, uh, very popular in, in the British Isles. Uh, you'd have to eat a lot of fish to get it. I, I think supplementation's probably the, the best thing to do. Along the, along the lines of dietary though, I would ma- I would make this point. Um, here in the United States, we have this, um, very poor, bad, fatal attraction to, uh, fructose corn syrup, high-fructose corn syrup. It's, it's sort of the sweetener of choice over here, and unfortunately, it's, it's probably one of the worst that we can have. There's been a number of studies that have shown that high-fructose corn syrup can inactivate vitamin D and, and its, uh, effects downstream. So even though you might have good levels, consuming high, a lot of high-fructose corn syrup, um, is, is not a good idea. I, and I would just ask, uh, you know, if you pick up a can of, of Coke or Coca-Cola, I guess you guys call it, uh, pop or soda, I don't know. We call it cola. Um, uh, it's gonna be sweetened with high-fructose corn syrup if it's purchased in the United States. Do you know what they s- is it cane sugar? What do they use over there in Europe?

   5. RCDr. Rangan Chatterjee20:16

      Yeah, I think it is. It's, it's definitely not high-fructose corn syrup over here. But, but I think what you're saying really speaks to, as you call it, the Swiss model approach, which is you mentioned right at the start that the immune system uses inflammation as one of its tools to help us fight off whatever we're fighting, and you've mentioned vitamin D, but also now you're speaking to food, right? And where do we-

   6. RSDr. Roger Seheult20:41

      Yeah

   7. RCDr. Rangan Chatterjee20:41

      ... get high-fructose corn syrup? It's typically in highly processed foods. So-

   8. RSDr. Roger Seheult20:45

      Yeah

   9. RCDr. Rangan Chatterjee20:45

      ... um, maybe we don't have high-fructose corn syrup here as much in the UK and Europe, but we, we do have lots of highly processed foods that are potentially driving inflammation in our bodies and may also be having a similar role potentially.

   10. RSDr. Roger Seheult21:00

       Yeah. I would, I would love to talk on that. But to get back to your second part of the question in terms of the evolutionary role of that, um, it, it, it's an interesting topic because, um, the whole world is not under that same pressure. So if we go to the equator, um, you know, uh, my, my, my father's, uh, family is from Trinidad, and so that's, that's about as close to the equator as you can get. You just have a rainy season and a dry season. But, uh, the sun pretty much sets every day at 6:00 or 7:00. Um, and that's very different, of course, when you're up in the Nordic countries in the far north. Well, I, I've been thinking about this and I'm-- If there were, if there was a disadvantage for those people living at those high latitudes in terms of vitamin D, I find it very interesting that the same cultures that live at those very high extremes have found, I believe, ways of compensating for that vitamin D deficiency. And, uh, this, this is a whole nother topic of discussion, but, um, you notice that, that the cultures that, like for instance, the Swedes and the, and especially the Finns, use a lot of this hot and cold sauna and bath type of things, which have been shown very clearly to be immuno-enhancing, uh, activities. You don't see that activity, of course, in cultures that are living in the, uh, at, at the equator. So, uh, m- maybe more anthropological than evolutionary, but I think that it's interesting that these cultures that have lived there, I mean, for thousands and thousands of years, have come up with these ways of dealing with illnesses that they might get because of, uh, a said vitamin D deficiency.

   11. RCDr. Rangan Chatterjee22:39

       Yeah. I, I think that's, uh, that's really interesting to think about, isn't it? Of course, there are some cultures like the Inuits who eat huge amounts of fatty fish, which of course contains vitamin D. But then you also think about the modern world and take someone like myself. My mom and dad came over to the UK from India, so my kind of heritage is to be in the Indian subcontinent, where, you know, there's very different, uh, levels of sunlight throughout the year. And so take me and my genetic heritage out of that background and put me in the north of England, and you've got this mismatch which potentially taking vitamin D might help me address. So it's super fascinating when you think about all these things. But again, I just wanna make the point, as, as you have, that certainly here in the UK, between May and September i- are the only months when we are getting the right, uh, frequency of sunlight to actually make vitamin D. That's a sh- very short window, and

6. 23:40 – 28:07

   Vitamin D as Treatment, the SHADE Study and Taking It with K2

   1. RCDr. Rangan Chatterjee23:40

      even if you don't have the risk factors like dark skin, for example, very few of us are spending enough time outdoors to really, um, you know, get all the benefits, right? So I think it, I think this is a widespread problem, and I think the, the, the sort of last 18 months or so has really brought to the surface just how important, uh, vitamin D might be. Can I ask you, you know, there was lots of association studies, uh, with COVID-19 and other, and many other conditions with vitamin D, but I heard you recently talk about the SHaDe study in India, and I, and I'm really interested as to vitamin D as prevention, but also vitamin D as possible or one arm of possible treatment and how you think about that.

   2. RSDr. Roger Seheult24:22

      Yeah, that's a very good, uh, discussion topic. I was just ta- discussing this actually with a colleague of mine who's in, in Tennessee that was looking at this. Um, so as I mentioned before, the liver and the kidney put on a couple of hydroxyl groups, uh, some molecules onto this to activate it, and we feel that that active form is really what does the trick. The problem is, is that it takes about a week or so for these, um ... the, these chemical reactions to occur in the body, so that you could take vitamin D now, but it's not gonna become active for another week. So that's a problem if you're having patients that are coming into the hospital. Uh, so we're, now we're not talking about prevention, we're talking about treatment, and, uh, that active form can be prescribed over the counter, uh, or, or through prescription in a form called calcifediol. And there was a couple of studies that were done in Spain looking at the treatment, because they wanted something quickly that they, they could use called calcifediol, um, that's the active form of vitamin D, to see if it would work. And, and in those studies, it, it worked tremendous. I mean, there was a, uh, the, the ICU admission rate in those COVID patients went from 50% to literally 1%. The, the problem was is that they weren't able to replicate some of those studies. Uh, there was another study that was done in Barcelona. And so as I, as it stands right now, we don't really have large randomized controlled trials looking at active vitamin D in these patients with COVID-19 to show an improvement. And so what we're left with is supplementing, like y- what you mentioned in the SHADE study, where they took 60,000 international units of vitamin D, and they gave it daily for about a week. And what they found in that study, even though [laughs] they gave these massive doses, is they found that inflammatory markers improved, which was a surrogate for infection, and they found that the time to, uh, testing negative on a SARS-CoV-2 test had improved in those patients that got those whopping doses of vitamin D. So, um, interesting study, uh, probably needs to be, uh, reproduced. There was a, a similar study that was done in Brazil, where they gave a whopping 200,000 international units of, uh, of vitamin D one time to these patients coming into the hospital. In that study, nothing, nothing changed. It was a negative study. So, um, interesting results. Um, not sure if vitamin D is ready for primetime in terms of preventing it, but I'll tell you what, in all of the patients that I am seeing in the hospital that are coming in with COVID-19, we're putting them on vitamin D supplementation.

   3. RCDr. Rangan Chatterjee26:55

      Yeah. And that speaks to what you're saying, which is huge potential risk of benefit, very low risk of harm.

   4. RSDr. Roger Seheult27:03

      S-

   5. RCDr. Rangan Chatterjee27:03

      So we're talking about the immune system, we're talking about the things that we can all do to help, uh, reduce the likelihood that we're gonna get sick. Vitamin D is one of them. Before we leave vitamin D, um, there's a lot of talk about what we should be taking with vitamin D, because there's, of course, lots of other nutrients that work together in harmony, for example, with bone health, uh, and a- and actually vascular health as well. Vitamin K2 can be really important as well. Do you have any thoughts on how we take, uh, th- the supplements and whether we should be taking it alongside vitamin K2 as well?

   6. RSDr. Roger Seheult27:38

      Yeah, I think there's some data that, uh, shows that taking it with vitamin K2 is, is helpful in terms of, um, uh, of, of vascular health. Uh, I think the key though is if you're taking vitamin D and vitamin K, both of which are fat-soluble vitamins, that you take it with something that is fat soluble. That's gonna help stimulate the appropriate mechanisms in your body, like your, your bile and gallbladder, to make sure that that gets absorbed. Because, um, if, unless you're eating something that has some fatty food in it, uh, it's not gonna get well absorbed.

7. 28:07 – 31:41

   Sleep: The Most Important Immune Lever and Slow-Wave Sleep

   1. RCDr. Rangan Chatterjee28:07

      Great. So let's, let's park vitamin D for the moment. And then I wonder if we could move on to sleep. And the reason I wanna go to sleep next is because, you know, we're talking about this evolutionary basis potentially of vitamin D, light, sunlight is what gives us or has in the past given us most of our, uh, vitamin D levels in our body. And if we think about light, the other way our lives have changed dramatically is we've sort of flipped when we access light. We get probably, uh, not enough bright light in the days, and we probably get too much light in the evenings, and of course, this affects our circadian rhythm, this affects our sleep. So when we're thinking about things that we can do to support our immune system health, how important is sleep?

   2. RSDr. Roger Seheult28:56

      Oh, it's probably the most important thing that we can do. In fact, when we at Med- Medcram, that's the, uh, is the, uh, the YouTube channel and website that we publish on, when this, when coronavirus first came out and we didn't know how to treat this, we had nothing. Um, in fact, uh, the, the, the organizations were saying, "We don't know what to treat it with, but we know you shouldn't treat it with steroids." [laughs] And, and what do we find out in the end? The UK Recovery trials, that steroids work the, the best. What we were saying at the very beginning was, "Look, we don't..." On Medcram, we were saying, "We don't know what to treat this with, but we definitely know that there are some things that we know improve your immune system," and sleep was the first thing that we talked about. It's so huge. Uh, there's so many aspects to sleep. There have been studies that have shown that if you don't get enough sleep, your antibody titers, uh, after a vaccine, uh, are not gonna be high. We- we've shown, uh, there were studies that have been done where they took s- college students, which are our favorite subjects to use 'cause they'll do anything. Um, when you drop, uh, r- rhinovirus down their, their nostrils, that those that have had a better history of sleep in their past tend not to get infected with rhinovirus. Um, we know that cortisol levels are connected to how much s- sleep you get. We know that slow wave sleep, which is usually in the beginning part of the night, before 12:00 midnight, is connected to growth hormone. It's connected to physical wellbeing, mental wellbeing. I mean, uh, the list goes on and on and on about how sleep... And melatonin. Melatonin is a, is a huge anti-inflammatory medication, so just that by itself is, um, i- i- is an incredible, uh, tool to have melatonin in the body. So d- Here, this is basically the bottom line when it comes to sleep. Go to bed early, get at least seven hours of sleep, and wake up in the morning and feel well-rested. That's, that's really the bottom line with sleep. We can get into the details about why the first hours of sleep before midnight are so important. We can talk about slow-wave sleep and growth hormone, which is the, the essence of the fountain of youth. Um, growth hormone is secreted when you're young. It gets, it gets less as you get older. Uh, we can talk about, um, what's happening to society in general. Um, and we can talk about what it feels like when you say, "I need to get my sleep," and how that is, is negatively looked upon in society as weakness. We can talk about the s- people moving into the cities, traffic, having to get up earlier in the morning, and then getting home late at night, and our culture is to relax and watch television and kick back and eat big, big meals at night and go to bed late. I mean, there's so many things that we've done wrong in the last 100 years that impact sleep and, and here we are.

8. 31:41 – 43:12

   Resetting Circadian Rhythm: Evening Light, Morning Light and Hospital Lighting

   1. RCDr. Rangan Chatterjee31:41

      Yeah. Well, I wanna talk about all those things-

   2. RSDr. Roger Seheult31:43

      [laughs]

   3. RCDr. Rangan Chatterjee31:43

      ... 'cause I'm incredibly fascinated with all those topics. But I guess that top line, again, is that the things that we can do, if we take a few simple steps to try and improve our sleep health, we can have a profound impact on our immune health. But I guess it's a lot easier to pop a vitamin D supplement, isn't it?

   4. RSDr. Roger Seheult32:04

      Yes.

   5. RCDr. Rangan Chatterjee32:04

      Than actually have to proactively change our lifestyle. So again, Swiss cheese model, we're, we're gonna talk about doing multiple things. The more of them we manage to do, the, the more robust our immune system health is gonna be coming into the winter, which is gonna help prevent, yes, risk of viruses, but also help reduce our risk of all kinds of other immune-mediated inflammatory conditions, whether that be heart disease, um, you know, strokes, what- whatever, whatever it is. You know, having our immune system work better is always gonna be a good thing. So with sleep, let's start by talking about why are, why is the first hour or two, those hours before midnight, as you say, why are they so important? 'Cause we've heard that for what? 50 years? 100 years? That an hour before midnight is worth... Is it worth two after? Um, uh, but you think, is there any science to this, or is this just an old wives' tale?

   6. RSDr. Roger Seheult32:57

      No, it's absolutely, uh, it's, uh, it's, uh, it's amazing. Uh, I was reading, um, I was reading a, uh, a, some writing from a, a health, uh, journal, uh, back in the 1800s. You're absolutely right. We've been seeing this for 100 years. Um, a writer by the name of Ellen G. White, she's, uh, on the top 100 Smithsonian influential Americans of all time, and she wrote that saying. She said, "Two hours before midnight is worth, is worth more than four hours after midnight." And of course, they had no idea what slow-wave sleep was at the time. So here's the point. Slow-wave sleep is one of the stages of sleep, uh, that, that you get into early on in the night, and as the night goes on and on, it gets less and less and less, and what takes over is REM sleep. REM sleep is a completely different form of sleep. It's where you dream, you're paralyzed, your eyes move around. Uh, it's also helpful, but it's helpful in a different way. That slow-wave sleep that we see primarily towards the beginning of the night is coupled with growth hormone secretion. So this is the reason why that kids who get lots of sleep early on tend to get more growth hormone and, uh, that, that he- that helps with growth. It, it helps with, um, physical restorative sleep, mental restorative sleep, and that's when you can get it. If you go to bed late, your circadian rhythm, which is part of the, the, the regulation of when you sleep and what stages of sleep you're in at what time, are not gonna allow you to get that deep, slow-wave sleep, and so you've gotta go to bed early. Now, the problem is, here's the problem, is that that circadian rhythm, if it is... I- if your brain and your eyes are subjected to light late into the evening, that is, over time, going to shift your circadian rhythm to tell you not to go to bed at 10:00. It's gonna tell you to go to bed at 12:00, or as some of you who are listening here in the audience, maybe you're night owls. You go to bed at 1:00 or 2:00 in the morning. That is... You say, "Hey, look, I just can't go to bed before 1:00 or 2:00. I'm not tired." That is because your circadian rhythm is, uh, is, is somewhere over the Atlantic, uh, as opposed to, uh, as, as opposed to being, uh, in UK time, for those of you who are listening in the UK. What I mean to say is your circadian rhythm is shifted, and the reason why it's shifted is because you've exposed your eyes to bright light i- at 7:00, 8:00, 9:00, 10:00, 11:00, 12:00 at night, either watching television or looking at a laptop, watching the news, turning the lights on. Um, and so the way to get that back, there's two things that you need to do to get that back so you're getting sleepy at 10:00 and you can actually go to bed and get the benefit of that sleep, is number one, stop exposing your eyes to bright light at that late hour. Dim the lights. Turn things down. You know, a lot of people, uh, tend to have this filter on their iPads that make it instead of blue light, it goes to red light. Well, there was just a study that was published a few months ago that showed that, uh, that's worthless. It doesn't work. It's better to just turn the whole thing off. So that's the first thing to do. The second thing to do is that when you get up in the morning, is to expose your eyes to bright light, and what that will do is it will start to advance your circadian rhythm. So instead of feeling sleepy at 1:00 or 2:00 in the morning, you're starting to feel sleepy at 9:00 or 10:00 at night, and you're starting to come into that, uh, better sleep pattern.

   7. RCDr. Rangan Chatterjee36:18

      Yeah. It, it's, it's always great to hear these things. I think many of us need to hear these things repeatedly. We, we hear them. We, we start implementing it. Then we get back into bad habits. So it's, it's always great to have reminders from, you know, uh, world-leading experts like yourself on just how important this is. But, but again, it speaks to light, right? The human animal has evolved around lots and lots of light and light at the right times, and we've kind of- ironed out and sort of got rid of these natural rhythms. We spend too much time inside. We're, we're stuck with these devices right in front of our eyes late at night. And what's interesting about that study, that the internal devices within these, uh, w- within the software and the programs may not be working so well or, as you put it, are worthless. [laughs] I think one thing I've found useful with patients and myself are there's some, uh, I think it depends on which company you buy from, but I think there are some really good blue light blocking glasses that I know some people find incredibly helpful. I know my wife, when she first put them on maybe three years ago, and she would at the time maybe look at screens in the evening and, you know, like many of us do, um, she popped them on, and within 20 minutes she was just yawning. And it-- W- what's incredible is it just shows how, how many of us actually have artificially pushed our, our circadian rhythm back and actually, uh, you know, a lot of us think that we're night owls. And I, and I'm not saying none of us are at all, but I think many people who think they're night owls actually don't realize the impact that the light, the artificial light, is having on their circadian rhythms. And you take a lot of these people camping, and you find actually no, they, they fall asleep at half nine, 10:00. But keep them at home, they can't fall asleep till 1:00 AM.

   8. RSDr. Roger Seheult38:08

      Yeah, exactly. [laughs]

   9. RCDr. Rangan Chatterjee38:10

      Yeah.

   10. RSDr. Roger Seheult38:10

       Well, it's important to have that cycle. That, that's a very important cycle, um, the circadian rhythm cycle, in terms of getting sleep so that you can be ready for the next day.

   11. RCDr. Rangan Chatterjee38:22

       I think a lot of people have heard these days about blue light at night, but less people have heard about the importance of natural light first thing in the morning. And is that something you, you know, you-- Is that something you're getting a lot of feedback on from-- You know, you make all these incredible educational videos through Medcram. Uh, you're helping so many people. Do you get feedback from people that, "Oh, I kinda knew about blue light," Dot said, "But I'm not doing it, but I knew about it, but I wasn't aware of how important natural light is first thing in the morning"?

   12. RSDr. Roger Seheult38:55

       Yeah, there are some people that, uh, that relate to that, um, that haven't heard it, they haven't seen it, that they start to do it, and then there's an improvement.

   13. RCDr. Rangan Chatterjee39:03

       Yeah. Uh, in my, in my first book, um, which came out a few years ago, which was-- in the UK it was called The 4 Pillar Plan, um, one of my recommendations around natural light was like, look, yes, it's important, try and get 20 li- 20 minutes of natural light first thing in the morning, and, uh, maybe if you have a morning cup of tea or coffee, get outside in the garden and drink your cup of tea or coffee in the garden. And I know when I go around the country here in the UK, many people come up to me and say, "Doc, you know, for the last two, three years, I put my fleece on, I'm in the garden with my morning cup of coffee." So again, there may be someone listening to this or watching who thinks, "Actually, you know what? I might start trying that," because you're gonna have your hot drink anyway, but why not have it and set your circadian rhythm up for immune sys- uh, immune health at the same time, right?

   14. RSDr. Roger Seheult39:52

       Yeah, and, and that actually brings up a wh- whole nother, uh, issue there as well, which is, you know, in science, we always try to reduce things to their lowest common denominator. So in other words, we, we've said here, and, and someone listening to this might think that the entire reason why we need to go out and have, go into the sun is because of vitamin D. But, but that's actually not the case, and you're not saying it, I'm not saying it. I don't want anyone to think that. There was actually a recent study that was done that showed that there was a reduction in COVID-19 mortality in people who went outside more, and they couldn't relate it to vitamin D levels because the vitamin D levels that they were getting at this latitude could not have made a difference in terms of COVID-19. And, and we may know this because we know that there's a, a condition called SAD, S-A-D, Seasonal Affective Disorder, and it's obviously related to the amount of sunlight people are getting. And so there may be something more when you're recommending people go outside to drink their tea or coffee in the morning. Not only are they getting light from the sun, you know, they may not be getting enough vitamin D because it really needs to be overhead. The benefit they may be getting is something maybe outside of what we know is happening with vitamin D. I mean, there's fresh air, there's ventilation. You hear the birds chirping. There was a recent study that showed that the more green that you see in your daily life, it improves your overall health. Uh, I mean, these are really interesting things that we're starting to find out, that maybe we're-- we, we've, we've moved from the outside to the inside, and maybe we didn't, uh, do as well as we could have done in terms of health in the body in that change.

   15. RCDr. Rangan Chatterjee41:29

       Given how important light is, and given that you are a practicing acute care physician, do you ever wonder whether in the intensive care units or in the wards that we could sort of upgrade the lighting? Because I know w- you know, from working in hospitals, or I remember when my, my dad was really sick and I was a lo- spent a lot of time in hospitals with him. You know, there's these, there's a bright fluorescent lighting in the wards. In the evening when patients should be sleeping, there's bright lights going on. It's noisy. You must see it. And I-- Of course, you know, things take time to change, but given how important light is, do you feel that hospitals need to do a better job of actually upgrading the light systems to help support people's health?

   16. RSDr. Roger Seheult42:16

       Oh, let me tell you. I-- It is so frustrating. These things are built like prisons.

   17. RCDr. Rangan Chatterjee42:20

       Yeah, yeah.

   18. RSDr. Roger Seheult42:20

       They've got these tiny windows, and, uh, the lights are on. And I'll tell you, the, um, the night shift and the day shift come in and out of the intensive care unit. The patients don't know whether it's night or day. They get this thing called ICU psychosis because there's beeping and whistles going off at all times. We-- What we try to do now is, uh, we try to turn the lights down. We try to minimize interaction with the patients at night. We try to open up the blinds. So we try to work as best as we can with what we've been given, but we can't put w- we can't put windows where, you know, structural walls are. So, uh, in the new constructions, we're hoping that they're gonna take this into consideration. I, I noticed, though, on, on television shows, they ha- the, the hospital rooms are these bright windowed wi- you know- [laughs] Huge, huge rooms with windows everywhere. Uh, unfortunately, that's not the case in the hospital that I work in.

9. 43:12 – 54:01

   Diet, Red Meat, Sialic Acids and COVID Risk

   1. RCDr. Rangan Chatterjee43:12

      I wanna talk more about sleep, but maybe we'll come back to that later this time, because I wanna make sure that people who are tuning in know that there's multiple things that they can do to, to sort of take control of their health and help, you know, improve their immune system health. We mentioned, uh, vitamin D, we mentioned sleep and how important it is to, to try and prioritize that. We touched a bit on food before, didn't we, around high fructose corn syrup, and I wonder if you might wa- wanna expand a little bit on foods and how that impacts our immune system.

   2. RSDr. Roger Seheult43:45

      Yeah, so this is very controversial, because boy, you can't tell people what to eat or what not to eat. It's a very personal choice that l- I mean, let's face it, it's going into their body. So, uh, I realize all of that, but let's look at some of the data, and this goes way back. I mean, they've been looking at diet and food and inflammation for a long time. Um, there's actually been kind of a, a standoff between the United States data and the European data for some point there. Uh, a lot of the US data was looking at, um, meat and vegetarian diet in terms of longevity, and, uh, there was, uh, a number of studies that have come out fr- uh, the United... in the United States that showed that it didn't really matter whether it was processed or unprocessed meat, processed meat being like cold cuts, sausages, things of that nature, and red meats, um, w- is just obviously the meat that you'd buy at the, at the supermarket. Um, all of those things seem to be associated with particularly red meat, particularly with, um, inflammation and coronary disease, cardiovascular disease. Um, and then came the EPIC study, which was, uh, a European study, a very large, uh, heterogeneous, multi-nation study that looked at the same thing, but in their study they found that, that, that cardiovascular disease risk was only associated with processed meat, not so much unprocessed meat. Well, this went back and forth for a number of years, and, and, um, it, it, it's interesting, because the data now is, is seeming to go back, even the European data now, there was actually a huge UK biobank study that was published, oh, about six months ago that showed, a- again, epidemiologically, that both processed and unprocessed meats were associated with cardiovascular disease. And the question has always been, why? Why particularly red meat? I mean, it's not white meat, it's not fish. What is it about red meat that seems to increase inflammation, particularly in the vasculature and in the, in the colon particularly, which is obviously where the food goes? And, um, as of late, there has been some interesting advancements in the understanding of what, what's going on, and really it boils down to something called sialic acids. There's a group out of UC San Diego, uh, University of California San Diego, that's looking at this, and also a number of other groups, uh, particularly in France. What are sialic acids? So if you can imagine, you know, whenever you look at, um, uh, the, the proteins on the cells of certain... We've seen a lot of animations now because of coronavirus. They'll show you these spike proteins on the surface of the cell, but that's all they show you. They're actually not showing you everything. On top of those proteins are glycoproteins, and then on top of those are sialic acids, which are, are little, uh, sugar molecules. In fact, if you were to picture my arm, my arm would be like the protein, my hand would be the glycoproteins, and then on the very tips would be these sialic acids. So what are sialic acids? They are sugar compounds, and as it turns out, humans only make one type of sialic acid, and I'm gonna get a little bit nerdy, wonky here, uh, but, uh, it's called n- uh, Neu5Gc or Neu5Ac. Neu5Ac is the type of sialic acid that's produced only on human cells. Now, we have a gene in our body that used to produce Neu5Gc, but it's been irreparably damaged, and there's no human on the planet that makes Neu5Gc sialic acid. So if you were to look at the surface of human cells, they would be completely covered with sialic acids of the Neu5Ac type. I'll just call that Ac from now on. Now, if you look at animals, mammals particularly, so red meat, mammals, they make both Ac and Gc. And so the problem is, is that when you consume, when humans consume animals that have Neu5Ac and Neu5Gc sialic acids on their surface and ingest it, it gets absorbed into the body. The body can't tell, uh, the human body can't tell whether it's Ac or Gc, and they put Gc onto the cell surface in the body. So to the immune system, which is not used to seeing Ac, they see Gc now, and they see that as a foreign substance. There's been some great research out of, out of France that have looked at this where they actually painstakingly asked everybody for their diet. They saw what kind of foods they ate. They went out, measured the Gc content in those foods, and then went back to those same, uh, subjects and were able to measure anti-Gc antibodies, and they found a correlation with the diet that the more Gc they ate, the higher the antibodies in their blood. And they've, uh, fee- felt that this caused a, what they call a sialitis, or an inflammatory condition. And so they were able to connect these antibodies with, uh, the risk for colon cancer, and they believe this is also involved with inflammation in terms of coronary disease and cardiovascular disease. So it seems as though there may be a connection there. Uh, so when you're talking about immune system and diet, what you don't wanna have when you're talking about COVID-19 is a hyper-inflammatory condition, because, uh, it's just gonna knock you into the hospital with BMI and cardiovascular disease. So that, that's an interesting development that's just been published here in the last few months, and, um, there's other things we could talk about, but that's- that's one of those, uh, aspects that I think are interesting.

   3. RCDr. Rangan Chatterjee49:01

      Yeah, I mean, it's super interesting, and as you were sort of discussing that, you were talking about how The science is moving on as it always does, and, you know, we look at these epidemiological studies, we try and make conclusions, then we look at more, and it sort of seems to advance our understanding or potentially contradict what we had before. And I think it gets sometimes with diets incredibly confusing for the public to actually follow what they should be doing. It's certainly my view, having looked at a lot of this, um, science, and actually for at least 10 years now being actively helping my patients, uh, in a more chronic setting than, than yours, change their diets. I, I... The truth is I, I have found that if people stick to minimally processed foods as much as possible, the, the truth is I've seen patients do super well on minimally processed vegan diets. I've also seen patients do really well on minimally processed diets which contain red meats, uh, and a lot of fish. And I- my clinical experience has led me, i- in conjunction with the research, to feel that it's that unprocessed nature of the food that seems to make the biggest impact that I can see. But also I think you mentioned red meat, but I guess it's also what are you having in conjunction with that? Are you having lots of broccoli, and kale, and antioxidants, and blueberries, and, and raspberries, which may, you know, which, which is gonna be different than if you're having that, uh, red meat with, you know, fries, uh, and, you know, highly processed breads. Do you know what I mean? It's, it gets really complex-

   4. RSDr. Roger Seheult50:43

      Yeah

   5. RCDr. Rangan Chatterjee50:43

      ... doesn't it? And so how would you then summarize all that and give your patients a recommendation, say, "Look, these are the things I feel you should be doing with your diet to help improve your health at the moment"?

   6. RSDr. Roger Seheult50:55

      Yeah. Well, I mean, obviously there's a lot of room for, um, nuances in terms of the diet. I, I think we both agree that the processed foods, uh, need to go. Uh, whether or not they're red meat or not red meat, there's plenty of processed foods that, that have nothing to do with meat that are probably not good for you. Um, there was recently a study that was published though looking at this idea of, of red meat and carbohydrates. So, um, I know a lot of physicians that want to be very healthy, and they want to do healthy things, and they choose to have high protein, low carbohydrate diets. So you've heard of the paleo diet and you've heard of, um, you know, the Atkins, I guess, was the old term for it. Um, they recently looked at that in a, in a study that was done in a network of physicians, about 3,000 physicians in France, Spain, Italy, um, uh, Germany, the UK, and the United States. These were physicians on the frontline dealing with COVID, and this was a, a case control study where they looked at diet, and they asked them, you know, "Here, what, what kind of diet do you as- ascribe to? Do you, do you ascribe to a plant-based diet, uh, a pescatarian, vegetarian type of diet, or a high protein, low carbohydrate?" So that's key there is the low carbohydrate 'cause obviously carbohydrates get sort of this rap of, of being, uh, inflammatory. And what they found was in terms of COVID-19, after they, after they adjusted for age, after they adjusted for, um, the type of physician that they were in, in, uh, dealing with COVID-19, and soc- uh, socioeconomic, all those sorts of things, of course these were physicians, right? So there's not gonna be a lot of, of difference there. They found that those that were on the high protein, low carbohydrate diet had almost four times the risk for severe, moderate to severe COVID-19. Uh, that wasn't a causative study 'cause it was case control, so it was an associative, but you've gotta ask the question is what were they doing that made them four times at risk? And again, I go back in my mind at least to the, to the risk of inflammation. You've got the SARS-CoV-2 virus. It's attacking the ACE2 receptor. The ACE2 receptor is one of those things that converts angiotensin, uh, into, uh, you know, angiotensin, uh, II into angiotensin 1-7. So in other words, it's taking things that are very oxidative stress and turning it into reducing agents, and then when the virus binds the ACE2 receptor, it knocks it out. So now you have this oxidative stress test essentially, and those people that are on the edge, you can imagine on the edge of a cliff, they've got diabetes, hypertension, high BMI, that's, that's like a big wind blowing. Those people that are far away from the ed- from the, the cliff's edge are not gonna fall over. Those that are right on the edge because they've got diabetes, hypertension, they're gonna fall over, and those are the ones that end up in the hospital. So I'm looking the, at this from an inflammatory standpoint and, um, if that's the case, you know, looking at the data from my perspective, I, I would say, yeah, definitely get away from processed foods. No question about it. And I would, you know, as the saying goes, eat less food, more plants.

10. 54:01 – 59:30

    Oxidative Stress, Antioxidant Foods and N-acetylcysteine

    1. RCDr. Rangan Chatterjee54:01

       Yeah. You mentioned the term oxidative stress. Uh, could you explain what you mean by that for, for some people who, who, who may not be familiar with it?

    2. RSDr. Roger Seheult54:11

       Yeah. So oxidative stress is a term that is used, uh, in metabolism that when there's a lot of metabolism going on in your body, there are chemicals that are produced that have, uh, electrons on them that, uh, need to be taken care of, and they could cause, uh, problems with other systems in your body. So we'll name some of them. Hydrogen peroxide, hydroxy radicals, superoxide, all of these things need to be dealt with and, and the body actually has ways of dealing with it, but the ways that it has of dealing with it uses up, uh, products. So for instance, um, uh, glutathione uses, uh, is used in glutathione peroxidase, which is a enzyme which reduces things. Um, you've heard of, uh, N-acetylcysteine, which is a supplement that you can get over the counter, uh, in most places. That's a, a product that can be used to reduce things or antioxidize. Um, but, but you can also s- find these things in, in nature. So anything, any berry is gonna have Things packed full of antioxidants

    3. RCDr. Rangan Chatterjee55:16

       Yeah

    4. RSDr. Roger Seheult55:16

       These are things that reduce the oxidative stress of the body, which is important to have when you're talking about infections and immunity. So raspberries, blueberries, um, boysenberries, gooseberries, strawberries, uh, the, the, the list goes on and on. All of them are just packed-

    5. RCDr. Rangan Chatterjee55:33

       Yeah

    6. RSDr. Roger Seheult55:34

       ... full of these things. In fact, the chemicals themselves, the antioxidants, appear to be red and blue because of the way that, uh, they absorb light. And so, um, uh, these, these structures are just amazing. Beta carotene, uh, carrots, um, blueberries. Anyway

    7. RCDr. Rangan Chatterjee55:50

       Yeah

    8. RSDr. Roger Seheult55:50

       All of these things reduce and reduce oxidative stress. Oxidative stress is bad, because oxidative stress will cause inflammation, it damages DNA, and, uh, it's... it does really bad things to the body. Can cause cancer and, and inflammation.

    9. RCDr. Rangan Chatterjee56:05

       Yeah. And, and just to tie it in to what we've been talking about so far, yes, certain food choices, like all these berries, and I, I always double down on my berry consumption going into winter, um, that's gonna help reduce oxidative stress, but also vitamin D supplementation, right? [laughs]

    10. RSDr. Roger Seheult56:23

        Yeah.

    11. RCDr. Rangan Chatterjee56:23

        Also, getting in enough good quality sleep, those things as well help to reduce oxidation, oxidative stress in the body, and it's... The body is interconnected, right? It's not as if we do that one thing and it just helps on this one arm. Again, it speaks to the Swiss cheese model, that if you're sleeping more, you're eating more antioxidant-rich foods, you're optimizing your vitamin D levels, actually, you're gonna bring oxidative stress down, aren't you?

    12. RSDr. Roger Seheult56:51

        Yeah, absolutely. Absolutely.

    13. RCDr. Rangan Chatterjee56:54

        You mentioned N-acetylcysteine, or NAC for short. Um, we're trying to talk about things that we can do to help support our immune system, and there's some interesting data, I think, on NAC and how it might be helpful at the moment, so might be helpful for us to, um, you know, reduce our risk of infection. Is NAC something, you know, you know, you've seen much of the research on? Is it something you take yourself or would recommend with your patients?

    14. RSDr. Roger Seheult57:21

        Yeah, so I take, uh, N-acetylcysteine, 600 milligrams twice a day, but I don't do it every day of the year. So I will do it during a winter season, uh, again, for the same reasons that you point out. There was a s- the reason why I do that is because there was a study. [laughs] That's the reason why I do most things. Uh, there was a study that was done back in the '90s that looked at, prospectively, supplementation with N-acetylcysteine, 600 milligrams twice a day, for about three months during a flu season in the United States. And what they looked at is not only the number of infections that occurred with the flu, but also the severity. So what they found was that NAC had absolutely no impact on preventing you from getting the flu, which is what we would expect. But it did have an impact on the severity of the flu in terms of work days missed. And so what it showed was that the, a lot of the symptoms and the severity of the flu might be driven by oxidative stress. And why do we say that? It's because NAC, or N-acetylcysteine, helps recharge those systems in the body that help reduce and get rid of these antioxidants. So that's why I take NAC, 600 milligrams twice a day, and I usually do it during that winter period for about three months.

    15. RCDr. Rangan Chatterjee58:38

        Yeah. Me too. It completely makes sense. You know, NAC is the precursor, of course, to glutathione, which is often called the master antioxidant in the body, and if we're talking about oxidative stress driving a lot of the symptoms and, and a lot of the problems that we're facing, it, it stands to reason, doesn't it, that actually if you can make more glutathione, the master antioxidant, that is gonna help. And again, coming back to risk-benefit, I'm sure there's not an, there's not as many trials as we would like, uh, on NAC to see, uh, just how impactful it can be in a whole variety of different, uh, situations, but I think there's enough out there to make an educated, uh, decision and go, again, very, very low risk of harm, and potentially huge risk of benefit.

    16. RSDr. Roger Seheult59:27

        Exactly.

    17. RCDr. Rangan Chatterjee59:28

        Yeah. Super interesting.

11. 59:30 – 1:07:26

    Heat, Interferon and the Case for Hydrotherapy

    1. RCDr. Rangan Chatterjee59:30

       Now, so we've got vitamin D, sleep, we've got food, we've got potentially NAC supplementation for some people. You mentioned before that the Finns, on an evolutionary level, did they do something? Did they kinda figure out, "We're low in vitamin D in the winter, so we're gonna do some hot-cold therapy"? And I know this is something you're really passionate about, so I wanted to really sort of, um, get into this a little bit as to heat, cold, how can these things help support our immune system?

    2. RSDr. Roger Seheult1:00:02

       Yeah, so, uh, I, I, I've really looked into this, because I found it just fascinating in terms of the timing and what we've done in the past. So, um, so the... Yeah, you're absolutely right. The Finns almost religiously do this. So when they [laughs] , when they do studies in Finland on, on saunas, they have to say that if you use a sauna once a week, that's the control group, because everybody uses a sauna at least once a week, and they go up to two, three time. They have a, they have more saunas in Finland. They have enough saunas in Finland that everybody in Finland at once could go into a sauna, and there would be enough saunas to hold everybody. Um, and so it's-

    3. RCDr. Rangan Chatterjee1:00:36

       Wow

    4. RSDr. Roger Seheult1:00:36

       ... a great country to study this on. I mean, the Swedes and the, and the, you know, the Nordic, uh, countries, they, they'd use it, but not to the same degree. And I remember when the first, when the pandemic first started, looking at Finland to see whether or not they had improvement in their overall, uh, outcomes, and, and they actually, they were the ones that actually had the first case out of all the Nordic countries. They're the ones that, um, you know, had shut down just about as much as everybody else. Uh, most of the numbers, interestingly, were coming from Helsinki, and there was a Somalian, uh, group there in the capital that was g- having most of the cases, and I thought that was an interesting, uh, issue, because again, there may have been a vitamin D deficiency. Again, they're used to having a, a certain amount of sunlight where they are living, and being in Helsinki, uh, in, in Finland could certainly, uh, mean that they would be at risk for vitamin D deficiency. But if you were to take the Helsinki out of the equation, they had, uh... Well, even if you put it into the equation, they had great numbers. It was even better if they didn't. So what's the basis of this? Again, let's go back to the two types of the immune system. There is the innate immune system, and there's the adaptive immune system. What we now know about SARS-CoV-2 is that the proteins in SARS-CoV-2, and, and indeed other viruses as well, suppress the body's innate immune system. Uh, look, y- your innate-- your body's immune system is so well tuned that for most viruses, you're not gonna have a problem. For a virus to overtake the human body and cause an overwhelming infection, it has to have some sort of a mechanism where it cripples the innate immune system, and that, that is what was discovered with SARS-CO- with, with the first SARS virus in 2002, and it's no different for this one in, um, in SARS-CoV-2. There's been a number of papers that have been published on this. So the problem is, is that with the innate immune system crippled, the body gets infected in many cells, and then seven days later, the adaptive immune system turns on, and that's when we have the cytokine storm. So if it was possible for us to enhance the innate immune system in a way that the SARS-CoV-2 would not have free rein, not infect many cells, we might be able to stop this short. So what I'm talking about is something that we would ideally do right after someone felt sick, but well before they ha- were so sick that they had to go to the hospital. So we're talking about early treatment. So as it turns out, there is a way of enhancing that innate immune system, and it's actually very, very simple. It's, uh, with heat. This is exactly what the human body does itself. How many times have we taken, you know, Tylenol or paracetamol over there in the UK to suppress a fever, thinking that the fever was the problem? It's actually, it's actually the, [chuckles] one of the ways that the innate immune system has of signaling to the body that there is a foreign invader, and that the innate immune system has to go to work. What they have found in research is that the product of the innate immune system, which is something called interferon, which is a good thing. It's, it's a product that's made by the human body. It's well-named because it interferes with the virus. Um, what we have found that as the t- the body temperature goes up, the amount of interferon that is made goes up as well. In fact, when you hit about 39 degrees Celsius, there's a tenfold increase in interferon secretion from the macrophages in the innate immune system. Now, that's really important because when we look at some of the papers that have been published with SARS-CoV-2, we're seeing-- This was published in Science. It was a very prestigious, uh, journal, very, uh, uh, elegantly done, uh, paper that showed that as interferon levels go up in patients, the severity of the illness goes down. Some of the most severe cases of SARS-CoV-2 in this cohort of s- of studies were in patients that had very low vitamin-- uh, sorry, very low interferon levels, either from antibodies against them or from innate in- inborn errors of metabolism that didn't allow the body to make enough interferon. So clearly, the amount of interferon that is secreted is gonna have a huge impact on how the patient does. So that's bench top. How do we, how do we convert that into everyday life? Well, let's go back. Let's go back in history. Uh, there was a, a gentleman by the name-- it was an Austrian psychiatrist by the name of, uh, of Wagner-Jauregg. Uh, Dr. Ja- Wagner-Jauregg was in charge of an insane asylum in Austria, and he noticed that his neurosyphilis patients at the time, this was back in the 19, uh, hundreds, 1920s, they got better when they had a fever. And so he had this idea that if he could only bring up their temperature, maybe this would, uh, impact the neurosyphilis. So he actually infected them with the blood of people that had malaria. So he'd a- actually on purpose give these people malaria. Now, it was under a controlled situation, and they, they knew how to treat malaria. Um, and but sure enough, these high fevers that these patients had from the malaria cured the patients of their neurosyphilis, and then he simply cured the malaria, and they were, they were fine. For this, he won the Nobel Prize in 1927. The very next year was when we discovered penicillin, which is, uh, the treatment for neurosyphilis a- as well as many other things, and other antibiotics, of course, came from that. But here's the point. The point is, is that to do the type of work that you need to do to raise up the, the temperature, they used all sorts of things. They injected them with, with foreign proteins. But one of the most common things that they would do is they would put these patients in heat boxes or heat closets or heat them up with hot towels so that their body temperatures would come up. They'd be sweating. They'd do this for about 20 minutes, and then they would immediately cool them down. Very similar to the things that the Finns were doing in their Finnish saunas. Uh, and all of this took a lot of time. They had hospital sanitariums that were set up. Um, and, um, and it was very w- labor intensive. Now they could treat it with just a pill. And so what happened was is it's not that these things didn't work. It's just that they were labor intensive, and now with the advent of penicillin and these medications, we found things that were much cheaper, l- less labor intensive to do, and we've, we've gone down that road. Now, look, I, I'm an intensive care doctor. I give medications all the time to my patients, and I'm sure thankful that we have them. But it doesn't mean that these things that we used to do don't work, and so I think in a pandemic situation, these are things that we, that we sh- we should at least look at and see whether or not they might work in COVID-19

    5. RCDr. Rangan Chatterjee1:07:25

       I mean,

12. 1:07:26 – 1:22:59

    Western vs Eastern Medicine, Death and Prevention in the ICU

    1. RCDr. Rangan Chatterjee1:07:26

       so interesting to hear that kind of, that historical narrative there of, of, of all these other kinds of treatment modalities, particularly using heat. It, it strikes me that, as you say, huge benefit for medication in, in, in many situations, but also because we presumably got penicillin and we had this quicker, easier way to treat people, maybe we stopped studying and researching some of those other methods that actually cultures have been using-

    2. RSDr. Roger Seheult1:08:00

       Yeah

    3. RCDr. Rangan Chatterjee1:08:00

       ... for so long. If you talk to people of certain backgrounds, they'll, they'll tell you things like, um, "Oh, my mum used to tell me when I was sick to go and sit out in the sun and put more, I don't know, turmeric in my food."

    4. RSDr. Roger Seheult1:08:13

       Yeah.

    5. RCDr. Rangan Chatterjee1:08:13

       For example, that's not uncommon in Asian cultures. And then we get modern science showing what a powerful anti-inflammatory turmeric and curcumin is. Um, you know, we talk about sunlight in terms of vitamin D, but actually maybe it's also, as you say, we're, we're trying to reduce it as to it's just one thing, but we know the sunlight or just the natural light helps us set our body's circadian rhythm, that maybe the heat is also helping the innate immune system function better. It's quite incredible, isn't it, that we're almost having to relearn what we once knew?

    6. RSDr. Roger Seheult1:08:49

       Yeah, you know, I, I've-- When I've talked about this before, I've had people come up to me from multiple cultures. I've had people come up to me from Asia, from Iran, from South America, and they all have their flavor of how they do it, but it's essentially the same thing. What-- In, in Iran, they would go into the hot sand and, and, and try to heat up that way. If it was in Asia, it, you know, they did it a, a different way. South America, it was another way they did it. But it was all a, a variation on a theme, which was heating up the body briefly to, uh, to cause a fever and sweat, and then a cool down. Now, the question is what's the point of the cool down? Well, scientifically, we now understand that when you heat up the body, you wanna lock in that heat, and the cold can cause vasoconstriction, locks in that heat, and also causes a lot of demargination of white cells that can then go to the lymph nodes to do what they need to do. So, uh, it's, it's interesting, and what you were just saying made me think about this, you know, the, the sunlight, the fresh air, um, the, the hydrotherapy. Looking back, I found this very interesting article in-- published on May 1st, 1919, by a Dr. Wells Ruble. Now, now Dr. Wells Ruble was the medical director of the New England Sanitarium. This was in Boston, and this was a, uh, a system of sanitariums that were run by the Adventist Church at the time. And you have to understand that this was after, um, a very famous, uh, gentleman by the name of John Harvey Kellogg, who was the medical director of the Battle Creek Sanitarium, who essentially wrote the book on hydrotherapy. This was also the brother of the guy who invented Kellogg's Cornflakes. There was a lot of, uh, push at the time for understanding of health concepts and things of that nature. Well, he wrote in, in May of 1919, with the pandemic that was going on, [lip smack] that this was an ample opportunity to employ what they called rational s- rational treatment. And, and what did rational treatment involve? Here, here you have this contrast, because in the United States, you had these army hospitals that were using a lot of aspirin at the time because they felt that treating the fever was important because the, maybe the patients were dying of fever. Um, they were keeping them in the army camps inside the, inside these closed conditions, minimal ventilation, no, no exposure to sunlight. And so we knew what the statistics were in the army hospitals. Um, I mean, 20% of them came down with pneumonia, and another, uh, 40% of them died after they got pneumonia. Whereas in the, in the sanitariums, and there was about 10 of these in the Northeast, what they did was something completely different. They isolated them. They used no medication, so they didn't use any aspirin. They did hydrotherapy, which was heating up the body, cooling them down. They went out-- had 'em go outside, exposed to the sunlight, fresh air, all of the things that you and I were just talking about. And the amount of patients that went from initially infected with influenza to getting pneumonia was 2%, as opposed to the 20% that was going on over in the, um, in the army hospitals. The very few that did develop pneumonia, about 50% of those died, so it really didn't work after you had pneumonia, which is why I believe this is more of an early treatment. But overall, the case fatality rate was 6% in the army hospitals, just over 1% in the sanitariums. And, and when I look at that, published over 100 years ago now, um, I, I, I look at that and I say, "Wow, if this, this could be something that we could easily implement without a pharmacist, without testing, without a, a physician in any country of the world, so long as they have a way of heating something up, applying it, and then cooling them down," and imagine what we could do, uh, in those situations where we couldn't get medical care out fast enough. I, I think it, it actually may do, uh, quite a bit of good.

    7. RCDr. Rangan Chatterjee1:12:39

       It's incredibly humbling, isn't it, as a, as a clinician, to think over 100 years ago, some really good research was being published that we have somehow forgotten about. I mean, those reductions in pneumonia rates and case fatality rates are, are hugely significant, especially when you're, you're talking about them getting no sort of conventional treatments. All they're getting is this hot-cold therapy. So it's, it's really exciting. How do you see that fitting in with, you know, the widespread, uh, adoption of cold immersion now, particularly in the sort of wellness communities? Uh, Wim Hof, who I've spoken to before on my show, Wim's obviously doing a great job at elevating, uh, you know, how beneficial certain types of breathwork can be for our overall health and for our stress levels. He's also helping to promote awareness of ... potentially for some people how beneficial cold immersion can be, and lots of people now, through him, through many other methods as well, are trying out various forms of hot colds. It's quite interesting, isn't it, that there's this modern, almost epidemic of cold immersion advocates now? Uh, how does that fit in a little bit with kind of this research from the past? We're also, in the UK, I think there's some studies on cold water swimming and how that is helping people, uh, with depression. I don't know if you've seen any of those studies, but again, that's super interesting as well. It all fits into this whole big picture that you mentioned at the start, immune system, inflammation. We know many cases of depression are driven, uh, through inflammation, right? So help us put all that together if you, if, if you will.

    8. RSDr. Roger Seheult1:14:25

       Yeah. That [laughs] it's a lot of stuff there, but it, it, I see a recurring theme over and over again. Sometimes the most helpful remedies for the human condition are not packaged in a, i- i- in, in a pill, pill box. Um, and, uh, they're actually packaged in nature. And, um, not to say that there isn't a benefit from these things. I'll tell you, look, if someone comes in to the emergency room and they have a stroke, we are going to get a CT scan, we're gonna give them a thrombolytic, we're going to open up that. I mean, there's no- nothing in nature that I know that's gonna help right at that moment. So what, what I'm starting to find, if we wanna put all of this together, is things that are emergent, things that are urgent, things that are, um, in a pandemic, there are s- there are things that sometimes we have to use emergency measures require emergence ... I mean, emergency situations require emergency measures. But if we are looking at trying to get toward a healthier existence, I don't think the answer there is going to be in medications necessarily. I think the answer there is going to be in lifestyle and in, in healthy living, and I think the answers to those things have been around for many years. That's what I'm getting the sense of. Now, of course, there's exceptions on both sides, but again, I'm, I'm an advocate of the Swiss cheese model. If it works, add it to the Swiss cheese.

    9. RCDr. Rangan Chatterjee1:15:49

       Have you ever heard of the phrase, um, that James Nestor shared with me when he came on my show? I don't know who said it originally. I think he heard it from, uh, a friend of mine called Brian McKenzie, and I'm interested as to your take on this, given that you are an intensive care physician, but you also seem to have this really, you know, amazing passion for lifestyle and nature and what we can do for our prevention as well. The quote is, "I think that Western medicine helps us not to die. Eastern medicine teaches us how to live."

    10. RSDr. Roger Seheult1:16:26

        [laughs]

    11. RCDr. Rangan Chatterjee1:16:27

        And I wonder what your perspective might be on that, given what you've been talking about so far.

    12. RSDr. Roger Seheult1:16:32

        Yeah. I, I think that's a reasonable thing. I would hate to say that, uh, the things that are ascribed, that are ascribed to Eastern medicine is only in Eastern medicine because I think, uh, um, as we've talked about before, a lot of those things were or- originally all over the world. But I think-

    13. RCDr. Rangan Chatterjee1:16:50

        Yeah

    14. RSDr. Roger Seheult1:16:50

        ... particularly in the West, we've lost it, um, and, and ceded it to the Eastern cultures, but I think it was there to begin with and it, and it still can be. Um, uh, but that's a very good point. We, we [laughs] there's another expression that we hear, uh, you may not have heard this, it's more of an American expression, that, that in, in, in America, death is optional. [laughs]

    15. RCDr. Rangan Chatterjee1:17:13

        Yeah.

    16. RSDr. Roger Seheult1:17:13

        So, you know, we always have something that we can do to keep you living, right? So, um, maybe not so, not maybe with a high quality of life, but, uh, it seems to be this, this, uh, binary, you know, alive or dead, uh, and that, and that's that, but that's not what we ought to be interested in. Uh, we wanna be interested in living fuller lives and, and, uh, and enjoying life and, uh, that, that's something really worthwhile, uh, attaining.

    17. RCDr. Rangan Chatterjee1:17:39

        As someone who does work in intensive care, that idea that death is optional is, is, is super interesting. Do you or have you found that you've had to really ask yourself questions about this in your work as a doctor where presumably you can keep people alive sometimes, uh, where there may be a case that actually is this the best thing for this patient? Is that something you've had to wrestle with, uh, as a practicing MD?

    18. RSDr. Roger Seheult1:18:07

        Oh, oh, yes. I, I can tell you because I have, I have cultural connections with the UK. As I mentioned, my, my mom, uh, was, is a nurse that trained in Birmingham. Uh, I have on my wife's side, who's Polish, she's got, um, family members there in Poland. Um, it's very different here in the United States. Uh, there is no age limit to what we can do or what, what we will do and, and, um, there's something about the American culture that means that, you know, we, we never give up. We keep going, [laughs] um, no matter what it is. Uh, that culture is changing. Uh, people are starting to accept that a little bit more, that, you know, we have to look at quality of life, and I, uh, oftentimes will have patients that have absolutely no quality of life and, um, we'll be asking families, you know, do we need to put, uh, instead of them being on the ventilator, we'll switch them over to a tracheostomy, which allows them to be on a ventilator in a, in a, in a warehouse essentially, in an institution, uh, to see if they'll get, to see if they'll get better. Now, oftentimes it's a, it's a reasonable thing to do because they need the rehabilitation. Um, but other times it's just for the fact that, uh, that we don't want them to die. We just want them to stay alive, and we, we oftentimes, uh, have discussions with families and try to explain these sorts of things. But it is definitely, um, a, uh, an area that we spend a lot of time talking to families about and educating them, and I think, uh, there, I think as a society, America is coming around to understanding some of those issues, um, that it's not, you know, staying alive is good and dying is bad. The question is more nuanced than that

    19. RCDr. Rangan Chatterjee1:19:46

        Do you feel that being an intensive care doctor has made you more passionate about prevention and the things that we can do in the first place to prevent ourselves ending up there in the first place? Or have you always had this passion, or do you feel that passion has developed as you've gone throughout your career?

    20. RSDr. Roger Seheult1:20:04

        Yeah, that's a very good question. Um, and I'll tell you, I did not come around to thinking about prevention as much as I should have until, uh, coronavirus came around, and then I had to really start thinking, "Look, here's a pandemic. People are going to die. We don't have things that we can do to stop it that we know of. We don't have randomized controlled trials that have been done and published in big journals like The Lancet. Um, but what- let's now start looking at things that we can do to improve our lifestyle so that we can withstand this wave that is coming." And that, that has really driven me, because I've had to look at these things to be able to dissect them and find out what it is that, that works. Uh, but now, now that you mention that, when I go back to the ICU, yes, a lot of the, the diseases that I see in the intensive care unit are the result of abuses that have happened over years and years and years. Uh, whether it's, uh, smoking, whether it is drug use, whether it is alcohol, uh, all of these sort of abuses that have hur- that have occurred, uh, cause these patients to show up. And, you know, in, in the United States we have, and I'm sure you do as well, have rules against, um, you know, they have rules for keeping things, uh, private and, um, you know, not, uh, you know, talking about patients and, and names and things of that nature. But I would really love, if we could somehow do this, have the public come in and see the type of things that happen with some of this living and see the results, uh, at the end so they know where, where, where this is leading to. Um, I, I think that would be very educational, 'cause people don't see it-

    21. RCDr. Rangan Chatterjee1:21:44

        Yeah

    22. RSDr. Roger Seheult1:21:44

        ... and we can't talk about it.

    23. RCDr. Rangan Chatterjee1:21:45

        Yeah. One of, one of my best friends, um, a chap called Karen, who, he works in a place called Chamonix in France, at the foot of Mont Blanc, and he's, uh, an acute care physi- he's an i- uh, he works in the ER there, he works in intensive care there. And a few years ago, when I was in Chamonix on holiday, I remember saying to him, "Hey..." 'Cause he knows what I do and that I'm all for promoting healthy lifestyles as much as possible with as many people as possible. And I said to him, many years ago, "Hey mate, I guess it's not as relevant for you, 'cause you're seeing people who really do need acute medicine and the best that we've got." And he said, "No mate, not at all. It's, it's even more relevant [laughs] for me."

    24. RSDr. Roger Seheult1:22:27

        For me.

    25. RCDr. Rangan Chatterjee1:22:27

        "I'm often sitting there in A&E talking about the stuff that you're talking about that they could do for their, for their mood or their lifestyle. It is just as relevant." So it's fascinating for me to hear that from my friend, but also from you in a, in a completely different country, a different healthcare setting.

    26. RSDr. Roger Seheult1:22:43

        Yeah.

    27. RCDr. Rangan Chatterjee1:22:43

        Your experience as an acute physician is helping you, well, or reminding you and all of us just how important paying attention to our lifestyle is.

    28. RSDr. Roger Seheult1:22:53

        Yeah. It's, it, uh, it's so sad, the things that we see on a daily basis. Yeah.

13. 1:22:59 – 1:31:26

    Practical Hot-Cold Therapy at Home and Contrast Showers

    1. RCDr. Rangan Chatterjee1:22:59

       Now, one of, one of the things that people often say about looking after ourselves is that it's expensive and it's not relevant. Uh, it's not, it's not accessible to all socioeconomic groups in society.

    2. RSDr. Roger Seheult1:23:13

       Yeah.

    3. RCDr. Rangan Chatterjee1:23:13

       And if we just talk about, if we talk this through about what we've spoken about so far, uh, vitamin D supplementation is very cheap, super cheap. Um, improving our sleep. There's lots of things we can do that are free. Now, I, I appreciate there can be a lot of stress in low socioeconomic groups which can make it harder, for sure. I don't want to sort of pretend that that's not going on. But again, there's a lot of simple things that we can do, like looking at natural light when you wake up, not looking at screens in the evening, caffeine consumption, you know, having it in the morning, et cetera, et cetera, that is accessible to people. Um, where do we go from that? Uh, we mentioned NAC, food. You know, there is a debate on whether it's cheap enough to eat healthily, and I mean, that's another topic, but I think there's good evidence to support that actually many of these foods are affordable for many people. Um, if we use that to hot/cold therapy, 'cause I wanna make sure, I really believe that good health is accessible to everyone, or it should be, and I feel as physicians, we, we, we really should, as much as possible, be making sure it's accessible to as many people as possible. Not everyone has access to a sauna. Not everyone can afford the gym membership to have a sauna. They can't afford to have one in their home. They don't have the space.

    4. RSDr. Roger Seheult1:24:35

       Right.

    5. RCDr. Rangan Chatterjee1:24:35

       So how does that hot/cold therapy apply itself to all of us?

    6. RSDr. Roger Seheult1:24:42

       Yeah. So first of all, before I forget, there are some great websites that, um, I didn't create, but I know that are out there that can talk more about this for, for your audience. So the first one is hydro, the number four- covid.com, so hydroforcovid.com, and that one's actually, uh, was created by a physiotherapist in Australia that really studied the, the protocols of John Harvey Kellogg and what he did at the turn of the century. And then there's another one that's, uh, even more practical than that, uh, called hydrotherapyathome.com, all one word, and that has a number of videos on there, and also just really how to do it yourself. And what it shows in those videos is how easy this is. So literally, you can have a, a pot of boiling water, you can have a microwave. You've gotta be very careful not to burn yourself in these things. But basically, heating up a wet towel and applying it, uh, on the body with, with a dry towel in between so you don't burn yourself, both on your back and your front. Um, and you basically cover yourself up in a towel to keep the heat in for about 20 minutes so you... until you have, um, s- you're sweating on your lip or your forehead. That means that basically your body temperature's going up and your body's trying to cool itself down, but it, you're not gonna allow it to do that. Putting your feet in a hot foot bath, um, all of these things are ways of increasing the body temperature, and have been used for, for decades, for probably hundreds of years, uh, to do this. And then after about 20 minutes of this, taking it all off and then applying a very cold, wet towel over the chest, and applying kind of a friction to stimulate and to cause vasoconstriction of the blood vessels and allow the demargination of the white blood cells. These are, these are things that, um, I didn't make up, but I'm, I'm learning about it. There's a, a number of institutes here in the United States that are actually doing this on patients. Um, one of them is called the Wiemar Institute here in, uh, northern California by Sacramento. Um, they have a number of people that have been doing this for years. There's been, uh, a number of schools that used to teach this. They stopped teaching it back in the '70s 'cause they thought it was useless, uh, because who's gonna do this, right? It's very labor intensive. Um, but if you, if you-- there are a few people that know still how to do this, [laughs] and it's a sort of a growing art. There's been a lot more interest, obviously because of coronavirus. But if you go to those two websites, uh, they will show you how to do it. But you're absolutely right. This is something that can be done very easily, um, in, in a situation where you don't need to have a lot of money. In fact, um, the, the gentleman, uh, who did the website, uh, Hydro for COVID, was a consultant when there was an outbreak of, uh, in, um, in, uh, Laos, actually, where they were showing them how to do these in, uh, refugee camps, and they could use black plastic bags and sit out in the sun and sort of heat up, uh, with trash bags, and then, and then cool off. So there's different ways of heating up the body, getting that temperature up, and then cooling down. So it's very inexpensive.

    7. RCDr. Rangan Chatterjee1:27:40

       How do you do it yourself, if, if you do at all? Sorry to interrupt. If you're enjoying this conversation, there's loads more like it on my channel. Please do press Subscribe and hit that bell. Now, back to the conversation.

    8. RSDr. Roger Seheult1:27:54

       I do. So, um, if I want to, just as a tonic, wanna make sure that I'm, I'm, I'm supporting my immune system, I actually have a spa that I've, uh, wired up to 104 degrees Fahrenheit, and we measure it in Fahrenheit here in the United States. Um, in the United States it's, uh, a law that you can't have a, a sa- or a spa or jacuzzi go up to more than 104 degrees. Um, so that's how I do it. But if I, if I'm really serious about it and I really wanna do it right, then I will, uh, spread a mat out, my wife will help me. We, uh, boil up some towels, put it down on the, on the, uh, the towels, lay on it, and then she'll put the towel over me. I'll put my feet in a hot foot bath that's really, really hot, but not burning, and you'll do that for 20 minutes, and I'll tell you, boy, you feel... You start to sweat all over your body, so you have to be well-hydrated. And after about 20 minutes she'll put that cold on and, and it's so... It's, it's interesting 'cause you feel so hot that you would think that cold is something that you don't wanna have, but you're actually waiting for that. [laughs] It's so hot. And then after about, uh, a minute or so of that, you go have a shower, you lay down in your bed. You feel exhausted, but boy, um, I've, I've done this in a couple of patients with COVID-19. They've called me and I've explained to them what to do and how to do it, and, uh, the symptoms, uh, at least in those, and this is not a study, this is anecdotal, the symptoms abated very quickly after about a couple of days.

    9. RCDr. Rangan Chatterjee1:29:18

       So that, that's in the early phase when people have just got sick, as opposed to in the late stage you were talking about earlier?

    10. RSDr. Roger Seheult1:29:24

        Exactly. So you don't wanna wait for a te- I mean, if you're feeling bad, if you're feeling like you have a muscle ache, you don't know if it's COVID-19 or not, but it doesn't matter because this is gonna help the innate immune system, which has to do its job anyway, so you don't need a... The beauty is you don't need a test, you don't need a doctor, you don't need a, uh, a pharmacist to, to initiate this. Now, I'm not saying you shouldn't get those. What I'm saying is this is something that you can do in conjunction with all of the other medical infrastructure part.

    11. RCDr. Rangan Chatterjee1:29:52

        What about hot and cold showers? Is that a simpler way and an easy way for people to, to try and, you know, activate some of these mechanisms that you, you've been talking about so far?

    12. RSDr. Roger Seheult1:30:03

        Yes, absolutely. The- these are known as contrast showers, the contrast being the hot and the cold. And the, the, the people that, that are the experts on this that I have learned from have come up with a formula that they believe will work, and, uh, it's five minutes hot, and then one minute cold, and then three minutes hot, and then one minute cold, and then three minutes hot, and then again one minute cold, and then you're done. So if you add all that up, it's about 19 minutes or so, if I do my math correctly. Um, but this is more of a tonic, so this is something to keep your immune system up and running and making sure that it's, it's surveying. If you start to come down with symptoms, I would probably recommend not doing the contrast showers, but doing something a little bit more, um, aggressive, like what we had just talked about.

    13. RCDr. Rangan Chatterjee1:30:48

        Yeah. Do we know what temperature we need to get up to on those hot/cold showers? Did they specify at all, or is it just hot and cold? 'Cause of course cold at different parts of the year, in the, in the height of the summer in the UK if we're having a, a good spell of weather, hey, a cold shower's pretty easy. It's like, "Yeah, I'm having-"

    14. RSDr. Roger Seheult1:31:04

        Yeah

    15. RCDr. Rangan Chatterjee1:31:04

        ... "a cold shower," but you try that in January, uh, it's, it's a very different experience of a cold shower.

    16. RSDr. Roger Seheult1:31:11

        Yeah, so you, you, they do actually specify, and I'm not, I'm remembering the numbers exactly, uh, but in Fahrenheit, you want the hottest, hot as you can tolerate it, and you really want the cold, like, down into the 60s or 50s.

    17. RCDr. Rangan Chatterjee1:31:23

        Wow.

    18. RSDr. Roger Seheult1:31:23

        Uh, that's kind of where you want it, which is pretty cold.

14. 1:31:26 – 1:38:45

    Nature, Forest Phytocides and the Seven-Day Rhythm

    1. RCDr. Rangan Chatterjee1:31:26

       In terms of other things, other simple things that we can do, you mentioned before, you said, I think, that there's a lot of great things that come packaged up in nature.

    2. RSDr. Roger Seheult1:31:35

       Yeah.

    3. RCDr. Rangan Chatterjee1:31:36

       And nature itself can be good for our immune system for, for multiple reasons, and I wonder whether you could speak to some of the benefits there are for our immune health when we get out in nature.

    4. RSDr. Roger Seheult1:31:51

       Yeah, absolutely. So there was a study that was done, um, a number of years ago by some oncologists that were looking at a way to support their patients' immune system while they were getting chemotherapy. Chemotherapy, as you know, uh, kills cells, um, the, the rapidly dividing cells of cancer, but unfortunately it also makes an impact on the immune system. So what they decided to do was add something called eucalyptus oil, so the, the oil of the eucalyptus tree, to an in vitro, um, uh, study, and it showed that the eucalyptus oil stimulated the innate immune system in terms of phagocytosis, that's eating, eating bad things, uh, up just as much as something called lipopolysaccharide for... And for those of you who don't know, lipopolysaccharide is a component of the cell wall, if you will, of, of gram-negative bacteria. So in other words, uh, bacteria activate the immune system. Eucalyptus oil does it to the same degree. And, uh, it actually makes sense. If you look back again at the pandemic of 1918, um, eucalyptus was used extensively. People knew that eucalyptus was a great antiseptic, uh, immune booster. In fact, even today, uh, it's one of the active ingredients in Vicks VapoRub that, uh, your mom probably rubbed on your neck [laughs] when you were, uh-

    5. RCDr. Rangan Chatterjee1:33:12

       She sure did

    6. RSDr. Roger Seheult1:33:13

       ... had a, had a... Yeah. So in f- in fact, if you smell eucalyptus oil, you'll say, "Oh, this is Vicks." Um, so, uh, eucalyptus oil, and that's just one of the aromatic compounds from one of the trees. So there was a study that was done in Japan where they took these Japanese, these really, um, uh, well-to-do executives from a, a Japanese company, and they took them up into the Japanese forest where the Hinoki cypress tree was, uh, indigenous. And, um, they had them walk around for a couple of days, uh, in the woods, and they measured what they call phytocides. Phytocides are these aromatic compounds that are given off by the trees, and they measured, uh, the innate immune system, the cells associated with the granules in the innate immune system, chromogranin A, chromogranin B, all of these things that go out and fight and, and are basically surrogate markers of the immune system. And what they found was that there was a definite elevation in all of those things when they went out into nature and they were exposed to these phytocides. So you say, okay, well, what was it? Was it the fact that they left work? Was it the fact that they went up to altitude? We don't know what it was. Well, they, they knew that. So what they did was they take, they took them now, and they went back down to Tokyo. They put them in a hotel, and they infused in the room the Hinoki cypress oil. Okay? And they found the exact same effects as they did when they were up in the forest, but there was one exception, and the one exception was is when they measured the cortisol levels in the urine. Now, you and I know that cortisol levels are a surrogate for stress. What they found was the cortisol levels in the h- hotel room were higher than the urine cortisol levels when they were up in the forest, which means that they were not only getting the benefit of these phytocides, which by the way lasted for about seven days, um, not only were they getting the benefit of that, but they were also getting the benefit of, of reduction in stress-

    7. RCDr. Rangan Chatterjee1:35:12

       Wow

    8. RSDr. Roger Seheult1:35:12

       ... overall as measured by cortisol levels. So there is a benefit in getting out into nature in terms of relaxation, but there's also an added benefit, and it doesn't have to be Hinoki cypress trees. It could be the fir, the pine. They all give off these, these, these phytocides that are natural compounds that seem to affect us in a way that it boosts our immune system.

    9. RCDr. Rangan Chatterjee1:35:34

       Yeah. I mean, it's incredible. I remember reading some of those studies a few years back, and I think in one of them that you mentioned, I think they even showed that the, the body's natural killer cells, of course, a very important part of our body's innate immune system that helps us, you know, eat up viruses, for example, that went up significantly, I think, in, in that study if, if, if my memory serves me correctly. And I, I like the fact that in Japan they've got this term for it, forest bathing. It's this cultural-

    10. RSDr. Roger Seheult1:36:01

        Yes

    11. RCDr. Rangan Chatterjee1:36:01

        ... thing that they do. And I, I guess in terms of trying to make practical recommendations, you're saying that, you're saying that actually those benefits lasted for about seven days.

    12. RSDr. Roger Seheult1:36:12

        Yeah.

    13. RCDr. Rangan Chatterjee1:36:12

        So could we extend that and say to people listening, to families listening, say, "Hey, look, maybe there could be, there could be," maybe we can't say this for sure, "but incredible benefit from a long hike in nature once a week." You know, do that as a family. It's gonna help bond you together. It's gonna help lower stress. But you may also be boosting your innate immune system, and maybe that will last till the following weekend. I mean, uh, you know, is that, is that a sensible recommendation, would you say?

    14. RSDr. Roger Seheult1:36:41

        Now... Oh, you, you, you are taking the words right out of my mouth. This is exactly where I, I, I wanna go with this because this is the, this is the next level. You know what fractals are, right?

    15. RCDr. Rangan Chatterjee1:36:52

        I do, yeah.

    16. RSDr. Roger Seheult1:36:52

        The fractal is, is, is a pattern, and then there's a pattern within a pattern, and that's, this is the next pattern up when we're talking about sleep in the 24-hour pattern because now we're going to the, the weekly pattern. And, um, science has shown very, very clearly that there is a seven-day cycle to the human body. Um, a- and if you think about it, this is quite, this is quite, uh, remarkable-

    17. RCDr. Rangan Chatterjee1:37:15

        Right

    18. RSDr. Roger Seheult1:37:15

        ... because if you look at the patterns that we have in society, right? We know that a year ... is related to how long it takes for the Earth to go around the sun. We know that a month is the time it takes for the moon to go around the Earth. We know that a day is the time it takes for the Earth to rota- rotate around its axis. What we don't have is some sort of a astro- astronomical way of understanding why do we seem to be attracted to a seven-day period, and yet every culture on the planet works on a seven-day period. I mean, in the French Revolution, they tried to go to 10 days. It just didn't work. They had to go back to seven days. And, and in, in fact, when we look at the human body and we look at the natural cycles in the body, we know that there, of course, is a circadian rhythm, but there's also a seven-day rhythm in the human body, a- as we've just pointed out here with this, with this study, but there's other ones that are related to s- to seven days as well, and it seems as though we need to have a day off. I, I remember I was watching, actually, one of your, one of your, uh, videos where you were talking about the fact that we just keep getting inundated by social media, by pages, by phone, 24 hours a day, seven days a week, it seems, and, and that we-- sometimes we need a, a time period to just shut down where we don't have that. We have this, this sort of this period of time for self, you know, reflection, uh, I think was the words that you used, and I, and I, I totally agree with that. I think that's one of the missing parts that I think is really important.

15. 1:38:45 – 1:49:47

    Spirituality, Community, Blue Zones and Connecting with Patients

    1. RCDr. Rangan Chatterjee1:38:45

       Yeah, I didn't know all of that about seven-day cycles. That's, that's super interesting. I certainly didn't know that the French-- in the French Revolution, they tried to go to 10 days. It's, it's really interesting, and, and I guess it speaks to this, the, the, the sort of wider connection that we as individual humans have to our heritage, but also, I guess, the planets, the moon, the sun, um, the sort of things we often don't talk about in medicine. Uh, I, I think it's always nice to put ourselves in that wider context. And I guess when, when we're thinking about health, Dr. Seheult, um, you know, how do you see that, that connection to something beyond ourselves? How important is spirituality and these, I guess, what we would call in medicine, the softer things, rather than-

    2. RSDr. Roger Seheult1:39:37

       Yeah

    3. RCDr. Rangan Chatterjee1:39:37

       ... you know, vitamin D will do this to your, uh, to your immune system. Sleep will increase, uh, natural killer cells. You know, the, these kind of things that we can, we can measure in, in, in very clean ways. You've been practicing, I think, I don't know how many years now. For me, it's just over 20 years. Um, I imagine for you it's been, been a long time as well. How-

    4. RSDr. Roger Seheult1:40:00

       Yeah

    5. RCDr. Rangan Chatterjee1:40:00

       ... you know, how do you look at these things? H- how do you look at the, the sort of wider big picture in spirituality in terms of our health as well?

    6. RSDr. Roger Seheult1:40:08

       Yeah. Well, absolutely. I, and I've been practicing for about 20 years, too. I think we may- maybe we [chuckles] we came on the scene around the same time. Um, I, I see it as something that's universal. Look, I mean, look at, uh-- there was a famous television show here in the United States called Cheers. You maybe you've, you've heard of Cheers.

    7. RCDr. Rangan Chatterjee1:40:25

       Yeah, we saw it.

    8. RSDr. Roger Seheult1:40:25

       Right. So what was the main theme? You wanna go where everybody knows your name, right? You wanna belong to something. You wanna be a part of something. You wanna have, uh-- There's something about being a part of a family, being a part of some sort of a, of a belief structure, um, and having something that you can depend on and someone that's gonna be there for you. And I think the studies have shown, you know, time and time again, that people that are in those kind of systems seem to do better than those that are alone, than those that have to deal with things by themselves. Uh, I think we're social creatures. And, you know, it-- talking about the spiritual aspect of it, you know, I'm, I'm informed by my own spirituality as well, um, uh, as being a Seventh-day Adventist growing up here in, in a Blue Zone. Um-

    9. RCDr. Rangan Chatterjee1:41:14

       Yeah.

    10. RSDr. Roger Seheult1:41:14

        So that's kind of where I'm, I'm sort of, of coming from this. Um, uh, Dr. Dan-- or Dan Buettner from National Geographic did a story a number of years ago on these Blue Zones, uh, in the world. One of them was in Sardinia, the other one was Okinawa, Japan, and the other one was, you know, Loma Linda in Southern California, where you, you [chuckles] where you can't see the mountains half the year because of the smog. Um, so, like, why Loma Linda? Um, well, uh, it, it seems as though it has those ingredients. It-- The interesting thing about Loma Linda is that it's not a genetically homogenous group. I mean, in Okinawa, Japan, you know, homogenous. In, in Sardinia, homogenous. Here in Southern California, um, you know, you have African Americans, you've got Hispanics, you've got Caucasians.

    11. RCDr. Rangan Chatterjee1:41:57

        Wow.

    12. RSDr. Roger Seheult1:41:57

        But they're all part of the Blue Zone, and, and the reason that he felt was is because of all of those things that we've just talked about: diet, feeling, uh, of, of togetherness, um, resting one day a week, being able to turn things off, um, and belief in a lot of these things, fresh air, exercise, getting outside. So, um, I think that's, that's, uh, where I would be coming from on that, on that topic in terms of spirituality, is being a part of something that g- that informs you and allows you to put your faith in something, and you're not, you're not exposed to the, to the ebb and flow of risk and stress by yourself on a daily basis.

    13. RCDr. Rangan Chatterjee1:42:37

        Yeah, so interesting. And, you know, I didn't know that Loma Linda... I knew-- I've spoken to Dan before. I'm a big fan of Dan's work. Um, I knew that was a Blue Zone, but I didn't know it was not genetically homogenous. So that really speaks to the power of the environment, doesn't it, and epigenetics. And it is really, really fascinating. You mentioned a couple of things there which I thought were, were, were really interesting, um, Dr. Seheult. Um, you mentioned that one day off a week to sort of switch off and rest, and I was actually explaining to my kids in the last couple of days, I was saying, "Hey, guys, you know, when we were little, the supermarkets were closed on Sundays."

    14. RSDr. Roger Seheult1:43:17

        Yeah.

    15. RCDr. Rangan Chatterjee1:43:17

        "You couldn't buy anything on a Sunday." Like, that was a day where- You would just rest really. You know, I remember when I first started going to France, even recently in France, in a lot of towns in France, the supermarkets are closed on Sunday. You, you, you have to do your shopping on a Saturday or you, you, you can't-- You don't have the option of going on a Sunday. Now, that is changing as we become more global and international as societies. These sort of things start to change, but this idea that you can now shop seven days a week, do the same things on a Sunday, or whatever day you choose to have that, you know? Of course, different faiths have different, uh, days where they switch off. You know, you know, the Jewish, uh, will, will typically do it, you know, Friday night to Saturday evening. Christians, Sunday, I think. Islamic countries, I think it's on a Friday. And you know-

    16. RSDr. Roger Seheult1:44:06

        Right

    17. RCDr. Rangan Chatterjee1:44:06

        ... the point is we've all-- that different faiths have got these seven-day cycles.

    18. RSDr. Roger Seheult1:44:11

        Right.

    19. RCDr. Rangan Chatterjee1:44:11

        And just having that one day where y- you're not doing the same things, allowing your body to reset. Maybe it's that one day where you go with your family, if you're lucky enough to have a family, out into nature for two or three hours and get all those benefits. You know, there is science behind it, but there's also something behavioral and cultural around this that we can bring in as well, isn't there?

    20. RSDr. Roger Seheult1:44:35

        Absolutely. Oh, totally. Uh, and I can't tell you, I mean, it's almost like a, it's a spot on the wall that, uh, that allows you to divide the endless demands that society and your work places on you to say, "I'm taking a break." And once you, once you've decided to say that this is what you're going to do, it's so easy then to say, uh, to, to, to, to say, "I'm not going to do-- I'm not going to go to work. I'm not gonna go do these things because this is the protected time that I have to take care of it." Uh, if you don't have it, if you haven't made that commitment, it's easy to allow things to creep in.

    21. RCDr. Rangan Chatterjee1:45:09

        Yeah.

    22. RSDr. Roger Seheult1:45:09

        Even if you have made the commitment, it's easy to allow things to creep in. So you have to have that. You have to start out saying it, and, and you will see that the, the benefits of being able to just put those things out of your mind And, and you-- I w- I, I'm so surprised that-- And, and now I'm not so surprised because sometimes when you put something down and you don't think about it, and then you come back to thinking about it again later, you see things in a different light, uh, maybe a clarity that you didn't have before. So there's, there's so many benefits.

    23. RCDr. Rangan Chatterjee1:45:38

        Is that something you find hard as a busy physician? There's a lot of patients who are depending on you. Of course, there's a lot of stress and demands with the job. But you also manage to find time to make some incredible educational videos that have literally helped millions of people get a better understanding of their health over the past few years, which, you know, I wanna acknowledge you for and just say what an incredible job you're doing at that. Um, how do you manage that yourself? 'Cause there must always be something else to do, right? Do you manage to, to, to actually have that switch off, or have you got some strategies that, that you try and implement?

    24. RSDr. Roger Seheult1:46:17

        Yeah, it's, it's been difficult. Um, you know, it was a lot easier before the [chuckles] the coronavirus pandemic, and since that time, things have just sort of taken off. But what we've tried to do is I've tried to, to, to keep, you know, things-- Like, so I don't make videos, I don't conduct business or do those things on the Sabbath. As Seventh-day Adventist, Friday night to Saturday night, so it's very similar to, to the Jews. Um, but, uh, so I've made that, uh, a priority. But then I've also tried to make a priority with-- 'Cause I have three kids as well, and they're all in school, and they all wanna, you know, to, to, to, you know, socialize and do things. And so you, you have to make a priority of things of what is, what is important in your life. And, um, that, that is always difficult. Uh, you're, you, you have a job to do. Um, obviously, there's times when I have to work in the intensive care unit on days that I would prefer to have off, on that day that I would prefer to have off. And so I, I use that as an opportunity to see things a little differently. Perhaps I might spend a little bit more time with my patients. Uh, oftentimes I pray with my patients. And, and you-- And, and as a physician, at first, when I would start to do that, um, I would-- I was ve- very self-conscious about it 'cause I thought that that patients would not want to have that. I have to tell you that I have not had a patient once say, "No, I don't wanna do that." So to me, it's, it's been a, a, a blessing in that in terms of me connecting with my patients. And I can see when I do that for my patients, that they-- It, it's almost like a weight has been lifted off. And [chuckles] it's funny too because they'll, they'll, they'll call their, their friends or their wife or, you know, at home, and they'll say, "You wouldn't believe what happened today. The doctor prayed with me." So, um, a- and I can see that it's touching them, and it goes again to what I was saying at, at the beginning. It's this universal thing. Everybody wants to go where everyone knows your name. It's just like that, that show Cheers really hit something. I think that's why it was such a hit because-

    25. RCDr. Rangan Chatterjee1:48:13

        Yeah

    26. RSDr. Roger Seheult1:48:13

        ... um, you know, we're not, we're not meeting some of those needs.

    27. RCDr. Rangan Chatterjee1:48:17

        And I think that discomfort you felt right at the start probably speaks to, you know, our fai- We, we all wanna connect with others, but I guess the way we feel culture's gone, we, we feel we can't open up or we can't be ourselves, or we can't share. Again, as a doctor, you know, I've faced this myself in the past. You know, should we have a certain image in society? Do we have to behave a certain way to be the doctor for this patient? But one thing I've learned in, in my years of practice is the more I take off my masks, the more I just be myself and-

    28. RSDr. Roger Seheult1:48:52

        Right

    29. RCDr. Rangan Chatterjee1:48:52

        ... let that patient see this shared common humanity, that the better the connection is. And I, I honestly feel the better the health outcome is as well when I do that.

    30. RSDr. Roger Seheult1:49:03

        Absolutely. I mean, and now, now you're not just a, a guy in a white, a white jacket. You're now a human being that they can connect with. And I, I can't tell you-- I-- It's funny. Wha-- I have a partner that works with me, and, um, he-- I don't know how he does it, but he, he just-- He's this character that, um, you know, he might, he might use a few choice words here and there when describing illnesses, that if you were to see it written down on paper, you'd be like, "Oh, that's, that's a little offensive." But the way he does it- With his patients that, th- you know, they really enjoy that down to earth, "Look, I'm here at your level, I'm talking to you, and, you know, I'm doing this because I love you, and, uh, I want-- this is what I want for you." And I think patients really appreciate that.
16. 1:49:47 – 1:55:35

    Dr. Seheult's Daily Routine and Closing Reflections

    1. RCDr. Rangan Chatterjee1:49:47

       Dr. Seheult, just to start wrapping up this conversation, um, huge part of today's chat has been about the immune system and inflammation. Of course, there's, uh, many other areas we could have gone down, and, uh, and, and I'm sure my audience will love this conversation, so if we can get you in the future, we- we'd love to go deep again on some other topics. But regarding immune system health then, I don't know if you'd be open to sharing , you know, you're, you're a super world-respected physician, you've shared a lot of science and data around the immune system. You, you work in intensive care. Are you willing to share what you do on a daily basis to help protect-

    2. RSDr. Roger Seheult1:50:24

       Sure

    3. RCDr. Rangan Chatterjee1:50:24

       ... your immune system as a way to inspire us to think about the things that we can do? And I appreciate you may have covered some of them already, but just as a way of sort of summarizing this towards the end.

    4. RSDr. Roger Seheult1:50:33

       Yeah, absolutely. So, um, you know, I try to get sleep early. It's hard for me to do that as a physician, but try to get to bed early, try to get up, try to, uh, expose my eyes to bright light in the morning, make sure my immune system is locked in there. Um, I try to get outside. I've, I've got a, you know, a couple of acres with some trees and, uh, some plants and vegetables. I get out there as often as I can and work around in the garden and, and fix things and try to get some exercise. Sometimes if I can't do it, it's in the wintertime, I'll, I'll, I'll just on purpose get some exercise, play with my kids. It's important to get exercise. That's one of the things that we, we didn't really-

    5. RCDr. Rangan Chatterjee1:51:07

       Yeah

    6. RSDr. Roger Seheult1:51:07

       ... delve into. We can save that for another time, but exercise is really important in terms of, uh, reduction. There was a study that just came out showing that people who exercise have reduced incidence of severe COVID, so that's really important. Um, and, uh, you know, that, that aspect of, of making sure that you have enough sleep, but also making sure that you're resting, um, on a weekly basis, getting away from the, the, the din and the, and the rat race so that h- hopefully you can reset. Um, in terms of supplements, I take vitamin D 5,000 units every day. I've done that because I've had my blood tested, and I wanted to get it up above 50, and that's what it took for me to get it up above 50, even though [chuckles] I live in Southern California. That should tell you-

    7. RCDr. Rangan Chatterjee1:51:49

       Yeah

    8. RSDr. Roger Seheult1:51:49

       ... uh, when you live indoors and work indoors, that's an issue. Um, I also take NAC, um, as well. Uh, my wife gives me, uh, some B vitamins, uh, uh, as well, and, um, fortunately she's the one that puts it on my plate in the morning. Otherwise, if it was up to me, I would probably have forgotten. Um, and then, um, you know, I, I take great, uh, pleasure and pride in, um, well, let's say pleasure in terms of making these videos and helping, um, other people, and I think that's what we all ought to do is, is you've gotta do something that you feel you, you've been called to do in terms of a purpose, and I think that helps. If you find something that you like to do, then, uh, as they, as the saying say- as the saying goes, "You'll never work a day in your life."

    9. RCDr. Rangan Chatterjee1:52:32

       Yeah. Some really, really practical tips there for people. And yeah, I love what you said, that you, you've been measuring your vitamin D levels to make sure you're getting to that optimal level. And of course, people, wherever they are, if they have access to that, they can also, uh, do the same thing. As you say, exercise, really, really important. We didn't mention that. We'll, we'll, we'll save that for next time. I think there's a lot on sleep we could have discussed-

    10. RSDr. Roger Seheult1:52:55

        Yeah

    11. RCDr. Rangan Chatterjee1:52:55

        ... and maybe fasting and things like that, which again, we'll probably-

    12. RSDr. Roger Seheult1:52:58

        Absolutely

    13. RCDr. Rangan Chatterjee1:52:58

        ... dive into next time. But, but I really just wanna say thank you because, um, it's been a real honor for me to talk to you for, for close to two hours. Uh, I know it's late for you, so I really appreciate you making time in your busy schedule. Uh, but you've clearly found something that is your purpose in your work with your clinic- you know, with your patients, but also your work online. Um, so thank you so much for that. Um, final question, I guess. This podcast is called Feel Better, Live More. When we feel better in ourselves, we get more out of life. You've shared so many tips today that we can do to improve our immune system health. But if I was to ask you, what is the one thing that you can do in your life that helps you feel better and get more out of your life? What would it be?

    14. RSDr. Roger Seheult1:53:44

        [sighs] I wish I could get into the spa more often. [laughs] It's, it's, it's really nice when you get in there and you get out. Um, um, I think that's, that's one thing that I wish I could do more. The other thing I wish I could do more is sleep. I think that's probably more than anything else, the thing that I probably don't practice as much as I should, uh, as I preach. And, uh, that's, that's, uh, a problem when you're a healthcare provider and you're expected to be up at all hours of the day and have all of these, uh, responsibilities. But I think for me, the irony is I'm a sleep physici- physician, and I probably don't sleep enough.

    15. RCDr. Rangan Chatterjee1:54:21

        I appreciate you being honest and sharing that. Um, I think a lot of us could... I think, again, hearing that from you makes a lot of us presumably feel less guilty 'cause we can-

    16. RSDr. Roger Seheult1:54:31

        [laughs]

    17. RCDr. Rangan Chatterjee1:54:31

        ... know things, but it doesn't mean we can always put them into practice.

    18. RSDr. Roger Seheult1:54:35

        Right.

    19. RCDr. Rangan Chatterjee1:54:35

        Uh, Dr. Seheult, if people wanna follow you and find out more about you, where are the best places they can find you?

    20. RSDr. Roger Seheult1:54:42

        Well, thank you. Uh, so on Medcram.com is our website. Uh, we have, uh, a number of videos there, also some videos for healthcare providers. For instance, if, uh, you're interested in learning about EKG and things of that nature, that's available. But, um, obviously on YouTube, uh, we have a channel there, Medcram as well, but we're also on Twitter and Instagram.

    21. RCDr. Rangan Chatterjee1:55:04

        Yeah. So everyone, go and follow, uh, Dr. Seheult there, catch up with what he's doing. Again, appreciate your time, and I look forward to the next time we get to have a conversation.

    22. RSDr. Roger Seheult1:55:13

        Thank you so much, Dr. Chatterjee. [upbeat music]

    23. RCDr. Rangan Chatterjee1:55:15

        If you enjoyed that conversation, I think you are going to love the one I had with the incredible immunologist Jenna Macciochi all about the immune system. It's right there, so give it a click and let me know what you think. And click here to download my free breathing PDF. Gut bugs, the microbiota, are one of the key educators of the immune system

Episode duration: 1:55:36