Boosting Viral Immunity with Dr. Patrick Hanaway

Apr 6, 2020 | Health, Podcast, Science

Episode Guest

Dr. Patrick Hanaway

Dr. Patrick Hanaway is a board-certified family physician with a medical degree from Washington University and residency training at the University of New Mexico.

He spent a decade as the Chief Medical Officer at Genova Diagnostics. Following that he became the Chief Medical Education Officer for the Institute for Functional Medicine as well as the founding Medical Director at the Cleveland Clinic Center for Functional Medicine. He still serves as a Research Collaborator there.

He is the past President of the American Board of Integrative Holistic Medicine and co-founded Family to Family: Your Home for Whole Family Health with his wife here in Asheville, NC.

As an initiated Marakame (Shaman) by the Hui-CHOL people in the Sierra Madres of central Mexico, he incorporates these healing approaches in his clinical practice.

Dr. Hanaway also leads the COVID-19 Taskforce for the Institute for Functional Medicine, aggregating the rapidly growing body of relevant research and empirical findings and translating into practical steps.

The content presented in this episode is intended as an information resource only. None of it is intended to be medical advice, diagnosis or treatment. Please consult with your medical practitioner or provider before attempting any new treatments.

Website(s): Family to Family, Your Home for Whole Health Care

In This Episode

  • 00:20 – Intro to Dr. Hanaway
  • 04:00 – What Dr. Hanaway and team are doing in light of the Covid-19 crisis
  • 07:10 – How can nutrition help our immune systems?
  • 10:00 – Quercetin and other helpful supplements
  • 18:15 – Vitamin D
  • 22:40 – Vitamin A
  • 24:30 – Ketogenic or low carb diets impact on inflammation and immunity
  • 31:30 – Diet and gut diversity
  • 33:30 – Dr. Hanaway’s take on probiotics
  • 37:20 – How does exercise help immunity?
  • 42:00 – Decreasing contagion
  • 46:30 – Using HRV and other biomarkers for early detection and stress management
  • 50:10 – Dr. Hanaway’s experience with monitoring HRV
  • 56:30 – The single best lifestyle action to boost your immune system
  • 1:00:00 – Wrap up

Episode Transcript

Ad: (00:01)
Welcome to the Elite HRV podcast where experts share their experience using heart rate variability and other biomarkers to optimize health and performance.

Vivek Minon: (00:11)
Hello, and welcome to another episode of the Elite HRV podcast. My name is Vivek Minon, I’m of the core team at Elite HRV. So you might notice today is a slightly different episode of our podcast without Jason, but really the main reason this episode is a little bit different is the public health crisis we are all in right now with coronavirus and COVID-19, this is a situation with personal risk for us here at Elite HRV, but probably also many of you. And that’s why we’re super pleased to have on the line with us, Dr. Patrick Hanaway. Dr. Hanaway is a board certified family physician with a degree from Washington University and residency at the University of New Mexico. He spent a decade as the chief medical officer at Genova diagnostics. One of the largest lab companies around followed by a tenure as the chief medical education officer for the Institute for Functional Medicine, where he was also the founding medical director at the Cleveland clinic center for functional medicine.

Vivek Minon: (01:29)
Dr. Hanaway still serves as a research collaborator there, and he’s also been the past president of the American board of integrative holistic medicine. And right now he’s busy with his family to family clinic with his wife here in Asheville. Very interestingly as well, Dr. Hanaway is an initiated shaman by the Huichol people in the Sierra Madres of central Mexico and even incorporates those healing practices into his way of doing things. So really overall, Dr. Hanaway, I feel like you bring sanity back to healing, and you’re transforming the conventional boundaries of medical practice with the education research and clinical care that you do. So thank you for joining us. I hope I didn’t miss anything in that introduction.

Dr. Hanaway: (02:22)
Just that I’m a dad, have two sons.Our whole family is here on our farm just North of Asheville and we’re spending as much time as we can out in nature as well.

Vivek Minon: (02:37)
That’s awesome. Yeah, that’s so important. And I think we’re going to get into some of those simple, yet effective things we can all do in this current situation. You know, I did also want to point out that Dr. Hanaway, you are also one of the leaders of the Institute for functional medicine task force for COVID-19 and, you know, as we were chatting before this discussion, you had mentioned that there’s some really interesting things going on with, with that task force and some knowledge dissemination that’s happening. So I would love to kind of maybe kick off the podcast with kind of what you’re doing there, and then we can transition to some of these great questions.

Dr. Hanaway: (03:23)
Thank you so much. It’s great to be on this. I’m a fan of Elite HRV and, and in particular, but in all tools that look at heart rate variability. I’ve been working with this both personally and in my clinical practice now for about 18 years. So it’s not a Johnny come lately type of thing. It’s really, deeply understanding how these tools can be useful, for ourselves and for our patients. So in terms of, of the Institute for functional medicine and what’s going on there, and, you know, I would say that we were a little late to the party in terms of recognizing that we needed to get out in front of this and what we’re, what we’ve been doing over the past week, week and a half is really gathering resources to be able to act as a clearing house.

Dr. Hanaway: (04:18)
That’s actually going to go live on, on Monday. I’m not sure when this podcast is going to run, but, that would be on, on Monday, April 6th, that the information is going out to our clinicians at this point in time. So that is to the educators, as well as all of the IFM CP certified practitioners around the country, about 1500 of them. We’re starting off with talking about virus specific nutraceutical and botanical agents. Next week, our focus will be really on boosting immunity and promoting resilience, different components that will be done. We’ll be talking more about HRV and stress in that time, as well as about, about nutrition. We’re going to go into testing. We’re going into, you know, deeper understandings of different kinds of, of herbs and supplements both in prevention and treatment that we’re going to be talking about medications, and there’s going to be a weekly release of information, as well as acting as a clearing house of, of information that our practitioners, over 1500 of them, have gathered and will be curated on our website and be available for anyone to be able to look at and read.

Dr. Hanaway: (05:36)
So those, those things will be coming out each Monday. You can go to the website,, and there’ll be a COVID link on the top of the webpage.

Vivek Minon: (05:47)
That’s great. We will definitely include that in this as well as on our platform. I’m really looking forward to that. I think, you know, there’s, there’s a lot of information that that kind of is out there in the media and other sources. We pulled our audience and we received a ton of questions on the topic of, you know, “what we should do and how we should approach this situation for ourselves and our loved ones?”. What we’ll do is some of the questions, the best answers still seem to be to the extent we know the answers they seem to be seen, and at the authorities like the who and the CDC and the European center for disease control. So we’ll definitely link to those, as well as the task force group.

Vivek Minon: (06:42)
But what we’re interested in here is, is kind of diving a little bit deeper into some of the mechanisms behind the things we can do to either prevent or reduce the severity of the illness. And you’ve mentioned a couple of them, and maybe we could start with the nutraceuticals and herbs that you mentioned that the group is looking at. And I know that’s a broad topic, but, you know, are there certain things we should be doing from a nutrition and supplementation standpoint, preventative wise, or if we believe we have been exposed to it?

Dr. Hanaway: (07:19)
Yeah, absolutely. I think I’ll start off and, and focus more on food and nutrition first, in terms of, of that looking at, you know, foods that are going to be high in polyphenols high in flavonoids, the vegetables, the fruits and vegetables that we’re eating are particularly important. At this point in time, we can talk a little bit later about the value of supporting the immune system of intermittent fasting. And, even for some people, a ketogenic diet that is going to be really helpful agents, to be able to really help support the immune system. Those are our key elements. So I always like to start with food first. I don’t want to jp to, Oh, the answers in the pill for an ill, but rather, you know, nutrition, a whole whole food diet, you know, really focused on those sugar cravings and try to remove sugar in any kind of processed, processed foods, processed grains at this point in time, high glycemic index foods, those are going to be important.

Dr. Hanaway: (08:18)
But when we, when we start to look at viral replication and what’s going on with the SARS CoV too, and there’s a lot of great resources out there for those who are interested in a deep dive on it, This podcast has got now, I think about 48, episodes that, that go into really understanding the pathophysiology of the attachment of the virus and how it works, but a lot of what we’ve, what we’ve done, you know, a lot of what we know is, is based upon our, analysis and papers that were on SARS CoV 1, looking at the mechanism of attack and what we want to do is we want to work to help decrease the overall proinflammatory cytokines, the uncontrolled release of proinflammatory cytokines that can cause, you know, cause irreversible damage to the respiratory epithelium.

Dr. Hanaway: (09:15)
It can also affect the mucosal epithelium of the gastrointestinal tract in a, in a subset of patients, although that doesn’t tend to lead to the serious, ARDSM, acute respiratory distress syndrome kinds of things. Then, the other things that we can do so we can decrease nuclear factor Kappa B activation. We can decrease this inflammasome that gets activated, by the, by the SARS to virus. And we can also decrease viral replication. Now, the data that we have is not specific to, for each of these kinds of agents is not specific to SARS CoV 2, but rather to other Coronaviruses, as well as other RNA based viruses. You know, so for instance, one of, one of my favorites, you know, you wouldn’t think of that right away, but it’s, you know, got a role as an antioxidant and an anti-inflammatory. It helps modulate the different pathways and helps to, decrease, viral replication that’s going on. And, you know, so Cystine, you know, usually dosing, you know, somewhere in the 500 milligrams, twice a day of the phytobiome source of that, and really doesn’t have a big risk profile associated with it.

Vivek Minon: (10:36)
And then Dr. Hanaway, when we talk about course D is it mechanism via zinc and its impact on zinc?
Dr. Hanaway: (10:45)
No, no, it’s not as specific a mechanism. It actually helps to modulate the, as I said, this thing called the NLRP three inflammasome, it decreases activation and it helps to modulate mass cell state, it stabilizes mass cells. And so it’s sort of antifibrotic fibrotic in that way. It’s got several different mechanisms and it also helps to inhibit viral replication, which may be as zinc, not zinc dependent, but, but collaborative was zinc along that you’ve mentioned zinc. Zinc is a great tool, demonstrated in many different studies. In fact, it’s hard to get sync in many resources at this point in times in gluconate is the one that’s been studied the most, and is a great tool to have in your, in your toolkit and to be used on the, on the prevention side of things.

Dr. Hanaway: (11:37)
I’ve got a list of agents here, you know, that include, curcin, elderberry, elderberry is a little controversial. There have been some, some questions about elderberry, that may actually precipitate as to authority to storm, or maybe at risk in patients who have autoimmune disease. There’s no data on patients with autoimmune disease of it being a risk. Certainly we’ve used elderberry for a long period of time in helping to decrease influenza, another RNA based virus. And so, you know, taking 500 milligrams of that per day, although there has been some caution raised and the risk in elderberry may be a little higher once people become infected. So if you have a fever, you know, sort of the, the judicious thing is to say, probably don’t continue on it after that period of time.

Dr. Hanaway: (12:31)
The evidence in terms of its benefit is really quite strong, made sure if you’re going to take an elderberry that you’ve got, something that’s, that’s standardized. So I say, you know, great for prevention of people starting to have a fever, I’d stop that, other things, you know, glutathione, NAC, and acid. Cystine, great, great as an agent to be able to help as an antioxidant, it’s supporting glutathione formation. It also acts, in a manner to be able to thin out the, the, the mucus and, and it’s really been demonstrated to be protective in an, in a number of different studies, doses on that usually 600 to 900 milligrams twice a day, you know, that’s working primarily through the repletion of glutathione. Some people may also be taking oral glutathione nber.

Dr. Hanaway: (13:32)
That’s a liposomal glutathione. That’s going to be more bioavailable than pills, per se. Other agents that I like: green tea, I drink lots of green tea. It’s the beneficial catechins that are, that are present in, in the green tea. And now some people will take ETCG at 225 milligrams per day. There is some rare but significant hepatotoxicity that can happen at that dose of EGCG. So I’m generally when I’m talking about that, I’m saying, gosh, it’d be so much better if you drank, like, you know, two to four cups of matcha a day and use that to substitute for your coffee. And that’s got all the benefits and it doesn’t have the, the risk profile, the harm profile that you get. If you take the EGCG supplement,

Vivek Minon: (14:29)
It’s tasty, and it’s a fun routine to make yourself a cup of matcha.

Dr. Hanaway: (14:35)
Yeah, I’ve, I’ve been really in the past. Interestingly, I used to be a big coffee drinker, you know, a coffee snob, and about a year and a half ago, I switched and after some personal changes, that I went through, I found that I really like green tea. I didn’t like it before that time, and now I’ve become a fan of Matcha. So I’m drinking, you know, generally like about four cups of matcha every day, and it’s just a routine through the day, something that’s there it’s part of the support. So other kinds of things like vitamin D, vitamin D there was one paper that came out by an integrative medicine group that raised questions about vitamin D, but actually the safety profile and risk of harm of vitamin D is tremendously good in terms of its mechanism of action.

Dr. Hanaway: (15:33)
You know, it stimulates antimicrobial peptides, and defenses, it helps modulate the regulatory or the T17 cells, it decreases the expression of transforming growth factor beta, it decreases cytokine expression, all of these things, great mechanisms of action and really good outcomes data. The one study that had indicated that it could potentially be a problem was in a most culture model in 2001. And the group followed up that study a year later and said, “oh, no, that’s not really a major effect.” It was looking at one specific action of vitamin D, its effect on the H2 receptor, which is where SARS CoV2 binds in the lungs and on the respiratory epithelium is on that specific receptor. It also to digress for a moment is also why there were some questions early on about, well, what about patients who have hypertension, who are on medications like in angiotensin eight and an ACE inhibitor or angiotensin receptor blocker. And there were some, there have been some evaluations, epidemiologically looking at that saying that are people who have hypertension and on those drugs at a significantly increased risk. And the answer is no. So we do not recommend it if people need to be on those kinds of medicines. There is no benefit to, to go off of those medicines at this point in time. That was a sort of a, a wondering early on because of the mechanism of attachment of the coronavirus onto the respiratory epithelium.

Vivek Minon: (17:10)
Yup. Yup. This is really interesting. And, but a couple, a couple of thoughts that spring to mind, one is, you mentioned earlier that on Dr. Roger C. Holt, his lectures have become like a nightly, a nightly ritual and, for me, and we will link to this in the show notes, but he in particular had a really nice breakdown of the H2 receptor in the role of, the, ARB and ACE inhibitors. So these blood pressure medications and what they do to ACE to, and then also how the corona virus fits in. So I watched one, I was somewhere…

Dr. Hanaway: (17:50)
In the early thirties, I think, but I do know exactly the episodes you’re talking about and, you know, for me, it’s very helpful. I don’t remember that stuff. Medical school was a long, long time ago, more than 35 years ago. And we didn’t know this stuff at that time, so it’s great. He does a really good job with his graphics and with simplifying, but not dumbing down the information.

Vivek Minon: (18:16)
Right, right. So the other thing I wanted to ask about or mentioned, cause you did mention vitamin D and then that’s a, that’s a great one because for a couple of reasons, one is, personally I’ve had great, a great experience supplementing with vitamin D you know, based on my skin color and where I live in the Northern latitudes. It’s, it’s pretty much guaranteed that, I’m quite deficient in vitamin D and, more anecdotal than anything else, but since, you know, appropriately supplementing vitamin D so not going too hard on it, but, since doing that, you know, it’s felt like my immunity has transformed quite a bit, particularly if I’m under stress from other sources, you know, mental or kids keeping me up and sleeping. And so, vitamin D seems like a good thing to explore considering that most of the world’s population is coming out of a winter with less sunlight and are now essentially at home, for large periods of time, you know, indoors largely as well on top of that. And so there’s probably some deficiencies to consider when it comes to vitamin D does.

Dr. Hanaway: (19:25)
Absolutely. And, you know, I remember, you know, it’s the, it’s the sunlight vitamin. So if you can get outside and you can get sunlight, you’ll make it yourself. And that’s, that’s even better. The data appears that that’s even better than taking it as a supplement. But you know, for those who are in larger urban environments and don’t have the capacity to be outside in nature or out in the sunlight to the same degree, certainly vitamin D usually I’m recommending for patients at 5,000. I use a day in the Northern latitudes, Southern latitudes sort of below Atlanta. Usually 2000 a day is sufficient. But, you know, that, that’s where I go. The other couple things I wanted to just touch base on were, vitamin a, which has been known to be very good for, for the, for the mucosa, and using doses that are going to, that’s going to be helping to modulate the T helper cells and, and, secretory IGA and helps modulate, cytokines, those things, vitamin date, a, 10,000 to 25,000 units a day.

Dr. Hanaway: (20:32)
You know, people when they’re treating with vitamin a will, will use higher doses, for a short period of time bursts of three to five days, you don’t want to be on doses higher than 25,000 for more than five days, you know, can be used as the early signs of, of fever, and doing that vitamin C also, very helpful. And there’s a new agent that, I don’t have a lot of clinical experience with, but where some, there are some interesting data on right now, and that is a, an anti-inflammatory, called Palmitoylethanolamide Pea, and the Pea has some interesting mechanisms of action where it, it helps with, with modulating viral production, you know, decreases the viral, cellular processes that are going on. And it helps the cellular defense mechanism. We don’t have great data on its harm.

Dr. Hanaway: (21:30)
It hasn’t been used a lot, but, you know, it does inhibit the sort of, primary things of, of TNF alpha and nuclear factor Kappa B, and helping with mass cell stabilization and doses that for prevention are in the 300, twice a day range of, of pea. There are some that are available also with luteolin, which has also been shown to be effective. So that’s kind of the, the broad list of, of options that are, that are available. You know, there’s some others that we’re investigating more deeply, that is a straggle list. Andrographis, Chinese skullcap, looking at some of the traditional Chinese medicines, things that have been used in, in Wolverhampton and in ways of being able to approach that we’re just getting into a deep dive on those, through the Institute for functional medicine right now.

Vivek Minon: (22:27)
Very cool. Very interesting. And, and just a quick question on vitamin A: do you recommend any kind of whole food sources to obtain that from, in addition to supplementing if necessary?

Dr. Hanaway: (22:42)
You know, every one of these things are going to be better in a whole food source, every single one of them. So by both getting credit noise, as well as getting vitamin A, vitamin D , you know, through various kinds of oily fishes and sardines and, and things of that nature, Cod liver oil, all of those things are great, are better sources. If you can get it from food, it’s better than getting it from a pill every time.

Vivek Minon: (23:12)
Yup. That makes sense. You know, we have, I have a five-year-old and a two year old, and we, we, we were, surprised by this, but they actually like the taste of Cod liver oil. And so part of me wonders, Oh, maybe we’re just conditioned to think it tastes poorly, or has a funny taste, but, this is a funny anecdote. The kids love their, their dose of Cod liver oil.

Dr. Hanaway: (23:35)
I think it’s important thing that you’re saying and that introducing our children to whole foods and, and, well-rounded palette and not overdoing sugar, or really avoiding sugar, early on helps them to have a much broader range of tastes than they then are the kids who are eating, you know, captain crunch and, and, you know, all the sugary cereals and, you know, unfortunately, even a lot of things that we get in our, in our organic markets, you know, when we’re going down that aisle of cereals and they may look all great and organic, but they still have a lot of sugar in them. So we need to be particularly careful with our kids about that, because we sort of raised them with a sweet tooth as unfortunately many of us were raised, with that promotion of the sweet tooth.

Vivek Minon: (24:23)
Right, right. That’s a great point. Yeah. It’s something that we don’t really think about this as being so pervasive, but you’re right. Especially as, as a child, on, and on that note, actually, one of the things you’d mentioned, Dr. Hanaway was kind of a ketogenic or low carb diet and its impact on either inflammation or immunity. And is there, you know, obviously one of the benefits of that kind of nutrition protocol is hopefully a reduction in these processed, high-glycemic, sugary ingredients. Is there anything else to the nutrition protocol that might be helpful, in this situation, you know, besides obviously the reduced intake of sugars?

Dr. Hanaway: (25:13)
Well,I’m a big fan of the, of the ketogenic diet, you know, across various kinds of applications. And so seeing that in people with diabetes, prediabetes, it does appear from the epidemiologic data that when we look at well: why are younger people getting sick in the United States? And so we see that 40% of the cases are happening, or I’m sorry, 30% of the cases are happening in, you know, people who are from 20 to 44 years old, 20% of the hospitalizations, this wasn’t seen in China at all. And one of the main factors appears to be obesity, that there’s a threefold increase, a risk of developing, serious infection and hospitalization, if you are obese now, you know, when we, when we look at the data on this, sadly enough, what we see is that, you know, 72% of the American population is overweight and 40% of it, 42% of it is obese, you know, and that’s, that’s increasing the risk.

Dr. Hanaway: (26:19)
And so looking at using the ketogenic diet to decrease the sugar, the sugars, feeding the viruses, you know, so that’s a key factor in what’s going on. So looking at the, the low glycemic index approach, one that is a low carb, you know, I like to think about a, a Mediterranean, low carb diet, which sounds counterintuitive, but, you know, really if we, if pull out the pastas and the breads from that, you know, even, we, we pull up those things, we can really do a lower carb diet, something that’s more in the 20% range, or, you know, we can take it all in, in those cases of patients who are willing and ready to be able to do it, a ketogenic diet. And, one of the things I want to highlight about the ketogenic diet from my own, research and investigation on this, and one of the things that I spend a lot of time on, you know, both, before and through my work with Genova diagnostics.

Dr. Hanaway: (27:15)
And so I teach about the gut microbiome. I’ve been teaching about that since 1991. We didn’t call it that back at that point in time, but the role of dysbiosis and imbalances in the gut microbiome so-called dysbiosis leads to an alteration of the T regulatory pathways. And so we see that the danger associated molecular patterns and the, and the pathogen associated molecular patterns, damps and PAMs that are upregulating the inflammatory pathways is that when we have dysbiosis and when we have obesity, these people are, are driving the inflammation, the, the, the Inflammatone, they, they, they have inflammation, that’s sort of inherently there and it’s driving the process. And so we can see it’s sort of like adding fuel to the fire that’s going on. And so the dietary approaches of a low carb diet have a low glycemic index diet of a ketogenic diet are all going to be helpful, but the caveat I want to add here, and, and this is emerging.

Dr. Hanaway: (28:18)
So, I’m, I’m looking at, at trying to understand, some data that I’m seeing, put forth. I haven’t been able to evaluate the validity of it yet. I’m going to go two ways here. So first I’m going to say the carnivore diet is said that your microbiome is great on a carnivore diet. I’m not convinced of that. I want to see the data on that, but what we have seen with people who were on a ketogenic diet is that it does tend to decrease the diversity of the gut microbiome. And we know that that’s a critically important factor in talking about the health of the gut, the health of the microbiome and the health of the body as a whole, and is an, is an indicator, a pointer to what your overall nutritional status is. So the key thing is actually ensuring it’s not just about getting, you know, 70, 80, 75, 80% fat in the diet, but it’s necessary to be able to ensure that you’re getting adequate a variety of phytonutrients and flavonoids, through the vegetables that you’re eating.

Dr. Hanaway: (29:27)
And, you know, like almost a keto-terian kind of approach, and you don’t have, you can eat from my perspective, you know, eating as an omnivore is great. And being ketogenic eating is omnivore, but I see a number of people who go and are really eliminating the food choices that they have. And you need to have an expanded opportunity of, you know, nine different kinds of, of vegetables every day, and looking down and seeing the phytonutrient spectrum of a rainbow color of whole foods on your plate, you know, at least one meal every day, you should look down and see five different colors on that plate. That’s really where the benefit is. And so as a ketogenic diet, when I’m talking with patients, that’s what I’m emphasizing, you know, and, and also then if you’re really gonna go ketogenic, I feel like you need to understand to be measuring your beta hydroxybutyrate.

Dr. Hanaway: (30:21)
There’s some good tools out there available. I’m much more of a fan just to dive into that for a moment, you know, while you can use a, a urine test over the first couple of weeks to see “am I starting to get into ketosis?”,once your body gets acclimated to it and you’ve dealt with the insulin resistance, that’s, that’s going on, your body will start holding onto those ketones. And so you really have to measure it through, I feel like the best tool is a, is a blood stick and the couple that I’ve seen and use our, the precision analytics and the keto mojo, they’re, they’re great tools and measuring that looking at, am I in nutritional ketosis somewhere between 0.7 and 1.5, you can go up to 2.0, but if you’re in the 0.7 to 1.5 range, you’re doing well on a nutritional ketosis, which is different than therapeutic ketosis, but nutritional ketosis will take you where you want and need to go. So, yeah,

Vivek Minon: (31:19)
Yeah, that’s, this makes, this makes total sense. So that’s, there’s actually a lot to unpack there. And if, if I could try to summarize some of the things that you mentioned, so, would specific to the ketogenic diet and kind of going lower carb to it. It makes sense to me that if you’re transitioning to that from a diet that’s been rich in high-glycemic sugary calories, that there’s probably some beneficial impact to the gut from just cutting those out. But over time, you know, not having all those phytonutrients and the variety of fibers and vegetables, it also makes sense that you’ve got diversity can be impacted. And, that’s important because it really does feel like, you know, our gut microbiome is this gigantic pharmaceutical factory that we harbor and it’s manufacturing all these drugs that are impacting pretty much every organ system in our body, including our immune system and the adaptive immune system.

Vivek Minon: (32:22)
So making sure that that pharmaceutical factory is appropriately tended for probably means, that you’re going to have a better inflammatory status. And so you’re probably not going to present some, these other diseases of inflammation, including, you know, obesity and hypertension and cardiovascular issues and diabetes and all this other stuff. So to me, it does make sense how the right structure of a ketogenic diet can really help not only reduce inflammation, but potentially then maybe get you a little bit less at risk for developing more serious issues. Is that, is that a fair statement? I know we probably don’t know that, but…

Dr. Hanaway: (33:12)
Well, it is a fair statement because we do see what the, what the role of, of the, of the gut microbiome is. Inactivating the NF Kappa B , you know, through what are called toll, like receptors. Now, one thing I want to highlight around this is that, you know, what I see in a number of different recommendations in this is, is then it’ll say, Oh yeah, and take a probiotic. And I’m particularly resistant to that. I would say that in my career, you know, 20 years ago, and more 30 years ago, I was saying, you know, take big doses of probiotics, have lots of different strains. What we now have a better understanding of is that probiotics act in very specific, specific probiotics act in specific ways. And we don’t know which probiotics are acting in specific ways in relation to SARS CoV2, and covert infection.

Dr. Hanaway: (34:10)
You know, so nonspecifically telling people to take probiotics to me is not a rational thing. Taking foods that have, that are cultured foods that have been used in, in different cultures over time is a great thing to do, whether it’s, you know, kimchi or sauerkraut or, kafirs and things of that nature, yogurts… but where I’m focusing more now is, well, let’s focus on prebiotics. Let’s focus on the absorbable fibers, such as Acacia root, and being able to use inulin using those kinds of things. And I also particularly favor the agents like, blueberry extract, cranberry extract, grape extract. And, what’s the other one I’m looking for: cranberry extract, all of which the flavonoids that are present there have been helped have been shown to help the anti-inflammatory bacteria to be able to grow.

Dr. Hanaway: (35:13)
So using probiotics and using those kinds of agents to be able to help the beneficial bacteria within you to grow, because we don’t know which probiotics are going to have the antiviral effect that is being desired, and nonspecifically taking probiotics isn’t necessarily going to help your gut microbiome to move into a more balanced state. I like to talk about probiotics as tourists. They’re transient. They move through, they don’t stick around the data’s there. It’s pretty clear. Now we’re learning. There may be a small percentage of them that stick around, but, you know, I can say that over the past 25 years of living in Asheville, I see a lot more tourists. I’m not convinced it helps the economy of, you know, it helps in the short term, it changes things. It definitely changes things, but it doesn’t actually lead towards long term sustainability. And so we don’t want to create a dependence on that. We want to use food as the food to feed our, our own gut microbiome, get it in balance and feed that properly. And so my focus is more on prebiotics and using those things, such as the agents that I’ve just mentioned to be able to help the beneficial bacteria within your own gut to be able to grow.

Vivek Minon: (36:27)
That makes perfect sense. And so you’re teaching yourself to fish rather than trying to just get, get free fish metaphorically.

Dr. Hanaway: (36:40)
Yeah. And so, just to say, there are situations where people need fish, you know, where you need to use a probiotic for a specific kind of thing. I’m not anti-probiotics, I’m just saying that they’re specific and targeted. And we don’t know what those specific and targeted probiotics are to be able to support our immune system, to decrease viral replication at this point in time.

Vivek Minon: (37:03)
Right. That makes sense. And, and so, you know, on the, while we’re on the topic of nourishing and supporting the gut microbiome, and we’ve talked a lot about the prebiotic fibers, the, the nutrition from foods and, from a lifestyle standpoint is what role does exercise play? And, you know, can we use exercise today, you know, as a way to not only nourish the gut microbiome, but, but by doing that, and perhaps other things that exercise does help boost our immune systems and, and, you know, put ourselves in a better position, here

Dr. Hanaway: (37:40)
Absolutely. You mean, there’s no question that, you know, moderate, regular exercise helps to boost our immune system. You know, it raises antibodies. It helps to promote circulation. It decreases our stress hormones. All of those aspects are very important. And so we see exercises having, you know, a great and wonderful role in the process of how to be able to support our immune system. Overall. We don’t want to miss that. What we want to be careful about is that now would not be a time, you know, for someone who is not, who has not been exercising regularly to jp in and do an aggressive, you know, three, four times a week hit routine to try to, jp in, that’s going to create a, a stress to the body. We know that things like, ultra endurance and running, you know, can have an effect, a negative effect on the permeability within the gut and with it, and with the immune system itself also. I mean, if you’re already out there and you’re doing training in that way, that’s fine and good to continue on with that, but now is not the time to really, super amp up your exercise routine and overly stress the body. So having, that’s why we talk about a moderate exercise routine. So, you know, from my perspective, and, and others will vary on this and I’m sure we’ll get some comments, you know, but looking at HIIT routines a couple of times a week, to be able to help with your overall exercise, endurance and capacity, you know, helping the concept of hormesis, what doesn’t kill you, makes you stronger. You want to be able to push the system to help it, to be able to grow, but you don’t want to over push it. And so finding out where that zone is, you know, that’s one of the things where, you know, a tool like Elite HRV, or some kind of evaluation of the heart rate variability is giving you a perfect biofeedback tool to say, “Hey, when am I overdoing it? When do I need to cut back?” And so, I’m a particular fan of it as a tool to be able to evaluate, you know, “where is my resilience, where am I over-training at this point in time?” And so it’s the beauty of it as a tool because you get, you know, biofeedback, it’s not like, “Oh, this doctor told me”, or “this trainer told me”, or, you know, “I watched this on a YouTube video and I’m going to do this. ” Something like P90X can be a great tool for helping to get someone in shape, but it can also tip you over and make you more susceptible if you’re overdoing it.

Dr. Hanaway: (40:24)
So use that HRV tool to give you feedback on “where I am at with my training and where am I at with my resilience at this point in time,” obviously that’s going to be taking into account those other important lifestyle factors. You know, we can’t underestimate the importance of sleep and deep sleep to be able to, you know, help in the re in the recovery process, you know, for individuals, you know, now’s not the time to, you know, binge watch “Ozarks” or, you know, some other kind of thing, and stay up late and not take care of yourself. I was talking to a patient this morning, you know, and just like the importance of having some, some routines in our lives. When we look at other cultures, they have daily routines that go on in our culture. Our daily routine often tends to revolve around our work.

Dr. Hanaway: (41:15)
So as our work structure is changing, you know, how do we develop routines to be able to do that? You know, get up, take a shower, you know, get dressed, look nice. Don’t stay in your pajamas, you know, go outside, do your exercise, do your morning, whether it’s meditation or prayer or yoga or Tai Chi is like, it doesn’t matter to me what that mechanism of helping to move into, you know, some grounded place of gratitude and connection at the beginning of the day, those are very important. And, you know, the studies have demonstrated that over and over again of the effect of those things on the immune system and find ways to take care of yourself. And then how do you deal with the stressors that come in? You know, we have new kinds of stressors where if I’m out running and it’s like someone’s running at me.

Dr. Hanaway: (42:09)
And as I do, I need to create six feet of distance, you know, in a, on a path that I’m running on, I can’t do that. Do I need to jp off to let them run by no, you know, the, the, the transmission, you know, it does not appear to be aerosolized and appears to be when we have hand contact, or, or we’re in the same space with someone who has it, you know, in less than six foot radius, you know, for a 10, 10 minute or longer period of time, you know, so, you know, we’re not gonna get it just like randomly passing people. It’s going to happen from the mailbox that we’re touching from the doorknob that we’re touching. You know, so when you’re touching different things, I’m sorta jping off into, I did want to spend just a moment just talking about, you know, what we need to do to decrease contagion, you know, the, it was great Vimeo from a Dr. Price, a pulmonologist in New York, you know, where he talks about this. He perseveres a little bit, you know, it’s about 45 minutes long, but it’s actually really good. You know, it was just talking about using soap and water, washing your hands, you touch something or use Purell, use something, you know, but clean your hands after you touch something. If you, you know, you’re going out and you’re, you’ve got to go, or someone’s got to go to the supermarket, a grocery store at some point in time. Okay. So, you know, wash your hands before you touch the cart, clean the cart, use the cart.When you’re done wash your hands again, and you go get in the car, wash your hands, you get home, wash your hands, you know, then that’s going to be the most helpful way to be able to do that.

Dr. Hanaway: (43:52)
And there’s some controversy now, just talking about spread of contagion about masks, should we use masks? We were told don’t use masks, you know, save them for the healthcare workers. Yes. The healthcare workers need the masks. They’re the highest risk population right now, you know, but now there’s some data that’s emerging. That’s saying, well, maybe we should really all be wearing masks to decrease our, our exposure. So that if we’re out in an arena where there are other people, when you have to go to the post office, or you gotta go to, the, the grocery store or the drug store, it does appear that wearing a mask is a good thing is the thing that will be helpful. And that’s sort of some changes, in our, in what we’ve been saying, over the past 24 hours. So we’re continuing to learn from this process, but develop routines.

Dr. Hanaway: (44:44)
At my point in coming into this is like develop routines around what you’re going to do, because if you’re relating to every single thing, if you’re relating to the ups driver dropping off your Amazon package as a threat, you know, it’s like, you just have them leave it on the, you know, I have them leave the box, you know, outside your door, you don’t have to engage him, you know, put a note on your door that has a signature on. It says I signed for everything and he’ll leave it outside your door and then, you know, go and when you get it, you know, use some gloves, get it, open the box, get the stuff out. If you want to be really specific about it, you can wipe that down, I think that there’s an overdoing of that, but, you know, the key thing is washing your hands so that your hands are clean when you go and you touch your face, you know, cause we say don’t touch the face, but ultimately we’re going to do that. If your hands are clean, you’re fine. So keep taking care of it in that way. That’s the key piece around helping to decrease contagion.

Vivek Minon: (45:47)
Do we know at this point, how long on different surfaces the virus sticks around? You know what I mean? If, if you needed to just leave it, leave it outside. Do you, do you recommend that?

Dr. Hanaway: (45:59)
48 to 72 hours on hard surfaces on stainless steel and glass? We don’t know the answer on cardboard. You know, I’ve heard, I’ve seen it written that it’s, you know, six hours should be fine, but we just don’t know. I mean, that’s all, it’s all conjecture at this point in time.

Vivek Minon: (46:18)
Yeah. So better, better to wash your hands after you handle it. That makes sense.

Dr. Hanaway: (46:22)
Exactly. Then, then you’ve got that taken care of.

Vivek Minon: (46:25)
Yeah. So one, one thing you did mention Dr. Hanaway is, you know, we, we were talking about exercise and the role of HRV as a way to kind of personalize the exercise dose so that it is moderate and not, you know, overly, stressful, for your particular physiology. And what else is going on in your life? We also talked about kind of anxiety and mental stress and how that can also weigh on you and, and literally the immune system, with HRV, you know, it seems pretty sensitive to the impact of stress from these sources. Do you recommend anything that we should be doing when looking at something like HRV or other biomarkers about our immune status or, you know, risk of illness? Is there anything there we should be looking at?

Dr. Hanaway: (47:19)
Yeah, the, the, the inflammatory markers are kind of, notoriously insensitive. So even like highly sensitive CRP, which is probably the best blood-based biomarker, we have to be able to look at inflammation. You know, I see many patients with autoimmune diseases whose HSC or P is completely normal. So there’s other inflammatory processes that are going on for those people who have autoimmune disease, then multiple conversations about this, you know, in theory, people with an autoimmune disease have an increased risk, in particular it’s those patients who are on medications that are immunomodulators. And as well as there is a question about the nonsteroidal antiinflammatories, ibuprofen in particular has been highlighted, although, Meloxicam and Naprosyn and other kinds of things. There’s question marks about that. We know those drugs will have effects on increasing intestinal permeability. So I tend to work to stay away from those kinds of medications.

Dr. Hanaway: (48:29)
But in talking about risk factors, I’m thinking more about what, what medications people are on and having multiple chronic diseases, those people are going to be at greater risk. So those who have an autoimmune disease probably do have some increased risk profile. We don’t have clear data on that at this point in time, those with an autoimmune disease who are taking some kind of immunomodulatory or immunosuppressive drug, methotrexate, anything that ends in M a B infliximab is an example of that. You know, those are people who are at increased risk of, of having, because they are actively suppressing their immune system. So those people need to be particularly careful. Are there other biomarkers that we have, you know, looking at dysbiosis in the gut is helpful to look at that. Looking at secretory IGA in the gut are helpful indicators or pointers to where there’s an imbalanced immune system that’s going on, but we don’t have great blood-based biomarkers, which is why I particularly like the HRV tool, because it’s going to give me real time information about what’s going on.

Dr. Hanaway: (49:41)
It’s going to tell me about where things are at in that, in that parasympathetic sympathetic tone, you know, am I, am I reaching a place of, of coherence within that? And that, that to me is really the key thing and what can I do to be able to change my routine and be able to get the feedback that shares and shows information to me. And I want to just tell a personal story about this, if, if I can. And that is, you know, so I’ve been monitoring my heart rate variability every day now for about a year and eight months. And, you know, I went through and I said, “well, gosh, my HRV is much lower than I thought would be.” You know, and I would have ups and downs, but, you know, so I said, “okay, well, I need to really…” at that point in time, I was eating keto and doing that

Dr. Hanaway: (50:36)
And it’s like, “Oh, well, that doesn’t seem to be enough.” And so I doubled down on my own prayer and meditation practice, you know, in terms of, kind of going from, you know, once a day to twice a day for 20 minutes. And, and that didn’t really make a difference for me. It helped me feel better, but it didn’t make a big difference for me. I began to focus more on my sleep and ensure that I got at least seven and a half hours of sleep a night, notoriously would not get enough sleep that made a little bit of difference, but not a big difference. Then I started spending time in nature on the land that I live on and we have some trails and, you know, very fortunate in that way. But not to get exercise, you know, and I was doing an exercise routine during that, you know, HIIT two to three times a week.

Dr. Hanaway: (51:28)
So sort of doing all the right elements and the HRV was stable. And, but it wasn’t, it wasn’t, it wasn’t high. It wasn’t, you know, the, the overall, amount of, of looking at where things were at was, you know, sort of consistent with a, 40 to 50 year old man, I’m 60, but I’m like, how do I get it down to, you know, being in a state of a 20 to 30 year old man? And, I started spending time in nature, just to wander and spend time in nature. It was a more creative time. It was a more reflective time and my HRV went up incredibly. It almost doubled. Wow. That tool is not the Elite HRV tool. That’s the aura tool. So, you know, a little different measurements, but, you know, looking at the same kinds of things I use both, I use the Elite HRV in the morning and I have the aura, maybe that’s belt and suspenders, but I like, I get different information from both of them and I find them to both be helpful.

Dr. Hanaway: (52:31)
So, so that’s, it’s going to be different. My point is it’s going to be different for each of us. You use yourself as the experimental tool to find out what are the things that make a difference in, in my HRV and begin to incorporate those into your daily practice. That’s, that’s the key thing. So, and, and that’s what’s going on with the data on HRV and sympathetic parasympathetic tone, and the immune system are very, very good. And so optimizing that is optimizing your chance to decrease the infectivity of what’s going on. So when we hear about this, we hear, you know, that about 20% of the people who get infected right. First do the things to decrease contagion. As I talked about earlier to decrease transmission, right? If you get it 20% of the people really aren’t having symptoms at all, 40% of the people are having mild symptoms.

Dr. Hanaway: (53:35)
20% of them are having severe symptoms. And another 20, another 20% are needing to be hospitalized. They’re so bad. And of those 10% are going to end up being, or 5% are going to end up being in the ICU. And right now it looks like maybe 1% of people are dying and they tend to be people who’s who, again, multiple complex, chronic disease, multiple comorbidities obese, all older, all the kinds of things that we would expect, but what can, what can we do to be able to minimize the impact on our body and what we’re talking about here, in terms of, of food lifestyle, the stress reduction, I HRV connection and relationships, connection to the natural world, all of those things. And then using some, if you like some kinds of nutraceuticals or botanicals that we talked about earlier, all of these are improving your opportunity to be able to optimize your health and wellbeing and to boost your immune system. So that if, and what it seems like when, the majority of us are going to get this right, do we, do we sit in that bucket of asymptomatic or mild? That’s what we want and when we get it, you know, to be able to, to, to quarantine ourselves, don’t put those, you know, our, our parents who may not have the same kind of lifestyle that we do, don’t put those people at risk if at all possible.

Vivek Minon: (55:09)
Yeah, no, that makes perfect sense. And it’s funny how this is an unprecedented situation yet when it comes down to what is the one thing to do lifestyle wise, to help the situation it’s still comes back to what you said, which is strive to be the best owner of your own health and wellness that you can by tackling basic things like your sleep, your nutrition, your movement, and exercise, and your mental stress and connection to nature and society. And just by doing that, using, you know, simple tools like HRV tracking and, and other things, that’s probably going to make the biggest difference for yourself and your loved ones over time. Because like you said, it will, if you do it over time and it’s not a magic pill, but if you, if you, you know, make it a part of your habits and your behavioral processes over time is probably the single best thing that can take you from being in that, you know, higher risk case to a lower risk case. And, and you know, if you’re using tools like HRV, you might even be able to tell when about to enter into a situation where you might be contagious. And so you’ll be better equipped to stay away at the same time.

Dr. Hanaway: (56:30)
Exactly, exactly. There was a question that you had posed, earlier, “what’s the single best lifestyle action you can take to boost your immune system?”. And, you know, I’m going to say, I feel it’s about having good relationships, having clarity in your connection with other people, this is a stressful time. We’re all going through, you know, things, it’s a quote I’ve heard many times: “the new normal.” We have no idea what the new normal is going to be, but we know that right now, things are different and change is stressful for all of us. So how we work in, in cultivating or deepening our relationships so that they aren’t a source of stress for us. You know, the, my friend, Dr. Mark Hyman talks about Vitamin L you know, the love vitamin, you know, love is medicine, and really it’s not to make light of anything, but rather it is to indicate that, you know, the importance of this cannot be underestimated.

Dr. Hanaway: (57:33)
And so particularly at these times of, I don’t like the term social isolation, because I don’t feel like I’m socially isolated. I’m talking to people all the time. I’m, I’m screen sharing, I’m doing Zoom, you know, Monday night dinner with an extended family of 18 people across five states, you know, and, and we’re connecting in ways that we haven’t connected in a long time. I’m connecting to the friends who I haven’t spent FaceTime with, or, or whenever I see them, we’re busy at meetings and we don’t just sit and chat and I’m able to do that now. And so the importance of those relationships and connection is, is particularly highlighted during this point in time. So take the time to do that and take the time to be with your, with your family and those who you love, who are around you and develop new routines to help you through the process.

Vivek Minon: (58:32)
That’s such a great perspective and such a great reminder, you know, the same amazing technological progress that we’ve made that has turned a local infection so quickly into a worldwide public health crisis also gives us the ability to stay so closely in touch with our loved ones all around the world. So if we’re suffering from one side of the equation of that progress, we should, we should take advantage of the tools we have to offer on the other side, by staying in touch and being grateful for those connections and being able to, you know, at the click of a button chat face to face with, somebody, thousands of miles away.

Dr. Hanaway: (59:14)
Exactly. Exactly. I have a bumper sticker on my old, my 30 year old pickup truck. “For fast acting relief, try slowing down.”

Vivek Minon: (59:25)
Amen. Stop and smell the roses. Well, I know that, speaking of relationships and depth of relationships, we’re, we’re really grateful to you, Dr. Hanaway for taking the time in such a busy, busy, and intense period to talk through some of your wisdom with us. I know we want to be mindful of your time, and I think we’re kind of coming up against your other commitments. Is there anything else we should, you’d want to chat about or mention regarding the current situation for our audience that we maybe haven’t hit on? , but at the end,

Dr. Hanaway: (01:00:06)
Well, we’ve, we have touched on it, but it’s more of putting a point on it. And that is that we’re at a time where we now begin to see that the, the, the busy-ness and the frenetic nature of our lives is one that, that has tended to put us at risk and that by connecting to ourselves and what’s going on, you know, using tools like what we’ve talked about, and, you know, I am a big fan of the, of the HRV tool is giving sort of immediate feedback on, on how am I doing so it doesn’t become a mental justification, but rather there’s some objective data that says, wow, I’m actually more, more stressed than I thought I was given the feedback, connecting to ourselves, connecting to each other. We talked about relationships and connecting to the natural world while, while things in our mind are frenetic. When we walk out in the natural world, it’s spring, things are coming forth, you know, take time to do that, connect to ourselves and the natural world. You know, that, to me, is the most important message of what we can do: be kind to yourself, be kind to each other, and use the kinds of tools that we’ve talked about here to be able to help and support you on that journey.

Vivek Minon: (01:01:38)
Wonderful. Couldn’t have put it better myself. And if we take anything away from this discussion, I think that’s a great place to start with. So thank you, Dr. Hanaway for, for, enlightening us. We will definitely link to the information that task force group puts out. And it sounds like there’s going to be all kinds of really interesting things coming out each week. And certainly there’ll be, there’ll be lots of questions and lots of learning along the way, but, I’m optimistic that, you know, we’ll, we’ll come through this and we’ll all be stronger for it afterwards, but in the meantime, thanks again. Ireally enjoyed this discussion.

Dr. Hanaway:
Well, thank you to Jason and the whole Elite HRV team and the work that y’all are doing in the world, helping to have a tool that gives people the opportunity to really improve their own health and wellbeing, is a great service and an important thing at this point in time. Thank you.

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