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How to Beat COVID-19

Western world may seem a little bit weird about traditional medicine but, there have been other systems of medicine long before Western medicine that were based on looking at the body as a whole system.

Today the immune system that is taught in medical schools is a system of immunity that really goes back probably to fifty to a hundred years ago.

For immunity, two factors matter -

1 . What do you put inside or on your body and this is a decision that you can make.

2. The second thing is what are we surrounded by viz. the air the water and the food and this is an infrastructure issue.

Current model of the immune system is used by the pharma industry to promote the concept of vaccines being the only way to heal our body or support the immune system which is absolutely not true.

Understanding Current Two Box Model Immune System —

So first of all what we see here is we have the

  1. Innate immune system which then integrates with the
  2. Adaptive immune system to create antibodies .

The innate immune system is that aspect of our body at the physical level, organ level all the way down to the cellular level that interacts with these pathogens that come from the outside — through our eyes, right through our mucosa in our nose, through our mouth, through our ears, through our skin and other orifices of our body.

This is where these pathogens when they come, first interact with what is called as our innate immune system.

The innate immune system is composed of, think about it as marines or the infantry. They just start going after trying to engulf these pathogens to take them out very quickly and they are nonspecific. This includes things like neutrophils and macrophages. The goal of innate immune system is to knock things out quickly and if things are working right it happens during the first few hours when we are experiencing some pathogens and thereafter what happens is the adaptive immune system kicks in.

The adaptive immune system are our sharpshooters. These sharpshooters include T cells and B cells which attempt to take out that particular pathogens by creating a particular antibody.

In a healthy individual the innate kicks in first and we don’t even notice it. This may be a little sniffle that we get and don’t feel that well and then adaptive kicks in and we create these antibodies and next time we are exposed to that particular pathogen we don’t even notice that nothing really happens.

Key point which is worth noting here is the understanding of the innate and the adaptive immune system that is still used to promote the vaccination model.

This model of the immune system theorizes that if you get those antibodies you’re fine you can move on.

The immune system which has emerged in the modern theory is very different than what we discussed above and there are alot more boxes to keep it simple.

What we see here is that, we have the innate system and we have the adaptive system. However there is something else between the innate and the adaptive it’s called the interferon system . The innate immune system communicates to the adaptive immune system and this interaction is through what is called as the interferon system. This interferon system is really the missing link.

The interferon system is a whole other system that up regulates all sorts of genes to interfere with viruses. This means our body is expecting pathogens and it trains its stuff to get stronger. But these three systems are not alone there’s a fourth system called the microbiome.

This system also includes what’s called the biome which has trillions of viruses in our body. The microbiome is bacteria. We have almost about sixty trillion bacteria in our body which is made of about six trillion cells .

Thus apart from our six trillion cells, we have also about ten times ie sixty trillion bacteria and then around three hundred sixty trillion viruses with a small number of fungi. Thus we already have hundreds of trillions of viruses in our body and tens of trillions of bacteria and all of these things are actually supporting life within us. And every time we shake hands with people, we are probably passing on to others hundreds of thousands or billions of viruses.

Going back to this diagram, what we see here is the microbiome and the viral interact through the gut brain access to our neural system. So essentially it’s a much more complex system than this concept that was used to promote the vaccination program in the 2 box model immune system.

So multiple things are involved if we get a virus or pathogen, the innate immune system kicks in the interferon system the adaptive our microbiome our viral and all of these things are beautifully organized in a choreography more importantly the gut bacteria interacts through the gut brain access to our brain. So think about that the gut and the brain are related and this isn’t important to understand because what this means is what you eat the, exogenous stuff that are in the environment toxins good things affect our gut bacteria and based on that balance you have good mental health. Neuro inflammation can be caused by gut imbalances so you are what you eat, your thoughts are a function of what you eat this is very very important to understand.

First of all viruses do not harm or kill

Reality of the public health infrastructure incapable of handling the fact that we have a whole assortment of people in this world today who have underlying pre-existing conditions. To put it simply they’re unhealthy people, their immune systems have been weakened and compromised by poor lifestyle choices and as ageing occurs they’re immunocompromised by the fact that we have poisonous air, poisonous water and poisonous food, horrible and decaying infrastructure.

Viruses do not harm or kill us. It is the overreaction of a weakened and dysfunctional immune system to the virus that results in our own body attacking its own cells tissues and organs.

It is not the virus that is killing , it is the overreaction of the immune system because in the natural state when our body has a proper nourishment, the proper conditions when we’re not being hit with all sorts of poisonous chemicals which affect our digestive system, affect our microbiome, effect our biome, we’re not being hit with poisonous air or poisonous water and we make the right choices to eat. You know high-quality vegetables our thyroid is working right we have proper hydrochloric acid. Our body is an amazing being. It knows how to take care of itself and that’s how we get immune health .

So let’s talk a little more about this so we can get back to basic science here. Now these dysfunctional immune response is a result of underlying pre-existing conditions like.

  1. Obesity.
  2. Diabetes.
  3. Heart disease.
  4. Smoking people being immuno compromised.
  5. Eating tons and tons of sugar in the diet when we should not be doing that.

The body in its natural state has all these components which work together to give us a strong immune system. Now that means we must take some personal responsibility for what we put in and around our body.

So this is what we have viruses which do not harm or kill us, it is the overreaction of the weakened and dysfunctional immune system to the virus that results in our own body attacking itself. We’re going to go through this and such a dysfunctional immune system as a result of underlying pre-existing conditions which here are some of them .

What we need to do to build this up so what happens when we age why is it in this situation that the people who are dying are people young plus and older. Well first of all as we age our thyroid level goes down.

This is where we have to speak about Vitamin A production whose production goes down because when our thyroid is not functioning right our body is not able to take carotenoids that we eat and convert them into vitamin A which is like a deadbolt which protects our cell walls.

It’s like building a wall so other invaders don’t come in. Hence vitamin A is critical to this but as we age our thyroid level goes down and and we minimize our vitamin A production. Now why is that important because vitamin A when that goes down we get less cytokeratins.

As you can see in the above image, these cytokeratins are the things that create the wall around our cells to really protect us.

The second thing we need to understand is that as we age our hydrochloric HCL acid level goes down. What does that mean to lower our gut acidophilus . But it’s a thing that our gut bacteria likes acid. When the acid levels go down, what happens at this point is that our microbiome goes into dysfunction so as we age, thyroid level goes down and we produce less vitamin A.

If we don’t address it properly then our acid levels goes down.

When acid level goes down our microbiome gets affected so again if we think about our throat in our gut, these two things as we age, getting affected and we go into what’s called as being immunocompromised. Our immune system gets weakened and it doesn’t act the way it should in that all those systems coming together in the proper way, our innate immune system, our IFN and our adaptive immune system etc balancing itself so this is why as we age it’s very important we focus on diet.

Other thing a number of people have been rightfully asking is if we eat a high sugar diet. FDA will not allow something to be branded as a jam or a jelly unless it has 30% sugar. So the sugar industry has manipulated the branding of jams and jellies.

Which is what our kids eat when they put it on there that it has to have a high amount of sugar otherwise you can’t sell. So what happens when you have a high sugar diet well when you have a high sugar diet Candida grows and a whole other set of organisms that start growing and when Candida growth occurs glio toxins increase and these toxins destroy your macrophages and t-cells.

So let me explain that what happens is you take in sugar and when you eat a lot of sugar which is like a drug your body will create Candida and will start growing and your body will make glio toxins so those glio toxins increase and what you start destroying your macrophages and your t-cells well why are they important well you know what they’re right over here they’re in your innate immune system and they’re in your adaptive immune system so you’re basically destroying the soldiers and the sharpshooter’s , destroying your Marines and that’s what sugar does. That’s what these glio toxins do and that destruction of your immune system the destruction of the glial toxin increase it destroys your macrophages and t-cells and what does that do to your innate and your adaptive immune systems and you have effectively screwed up your immune system.

So we fundamentally have the following taking place in a normal healthy individual the innate immune system will take care of that pathogen you would remember trillion viruses in our body.

In a normal healthy individual immune system will take care of the pathogen now in the non healthy individual be it an adult or a child the innate immune system is not able to take care of the pathogens because of the destruction through either sugar or the thyroid is not working right or you’re not getting adequate amounts of HCl.

So let me just review very simply in the nonhealthy individual what’s happening is that could occur two ways and it’s a whole area here when you’re under dirty air dirty water dirty food you’ve compromised your immune system your thyroid and your HCl levels are low whether your child or an ageing person and when that happens your body essentially is not producing the proper vitamin A, your gut bacteria is off and now you compromise your immune system.

Now add to that a lot of sugar diet well you’re further more doing to your body in a very unfortunate way is that your body’s macrophages and your t-cells the innate and the adaptive are being destroyed and now what happens remember it’s not the virus that kills or harms you what actually kills and harms you is what is called the cytokine storm.

Talking about cytokine storm what do we mean by that, well let’s go back here if you remember the above diagram we made for adaptive immune system, well among all of these are what are called cytokines which are a whole another set of chemicals that because your innate and your adaptive systems are harmed they say wow I got a help Bob out you know I got a help bill out what should I do because your body is trying to heal itself and so what it does then it unleashes a set of cytokines .

These are chemicals and are always at a certain level there but they start to overreact and this is the overreaction caused by those underlying conditions in people, whose systems have been weakened by the different areas that we just had a glimpse of above. So when the immune system is compromised you have a cytokine storm. All these other chemicals start raging to try to make up for the fact that the other subsystems have failed. I hope that’s clear very simple stuff your body tries to be in balance your body tries to protect you so it unleashes these cytokines it basically starts firing off missiles everywhere to saying oh my god I got to protect Bob okay and as a part of that what happens this cytokine storm these chemicals go and start attacking your own tissues.

So by way of example in Ebola the cytokines start leading to a collapse. By the way just to give you a visual understanding the viruses if you think about a virus it has a layer on it outside of it is called glycoproteins inside of that is the RNA which is the nucleic acids which go into your cell and take over your cell machinery but when that happens the pieces of the outside the glycoproteins you know there like that shedding hair they go settle all different places now in the case of Ebola these essentially go into the arterial endothelial which is in your arteries in your heart cells. This is why you start bleeding outside which you start basically you know bleeding from inside and that occurs because your own cytokines go over to that arterial endothelial cells and they start killing it.

Now in corona it is your cytokine storm that attacks the epithelium which is a different set of cells in your lungs.

So let me summarize that again your body’s compromised plus year old people are not working their systems which are compromised hence the body starts attacking in the case of corona virus the glycoproteins go embed in the cells of the epithelial cells and your own body cytokine because it’s compromised starts attacking the cell walls and you start having respiratory failure.

This is what happens so the bottom line here is let’s make it very clear again it’s not the viruses that harm you okay we have trillions of viruses within us we don’t see people have died it’s not like every human is dying but it is a compromising of the immune system that causes a cytokine storm.

How does that compromising occur dirty water dirty air dirty food horrible infrastructure you need to start making good choices by massive reduction in sugar diets where you gonna screw up your entire immune system you’re gonna create Candida etc and the other things you need to start having adequate nutrition.

Just to summarize when we look at this you know when you look at the cause of underlying pre-existing conditions like

  1. Lifestyle
  2. Poor dietary choices
  3. Lack of exercise
  4. Stress
  5. Lack of sleep
  6. Smoking and
  7. The environment which is dirty air dirty water dirty food. Arm yourself with knowledge because you know as someone an enlightened being once said it is ignorant that is a cause of suffering so let’s start teaching a little bit of knowledge here about vitamin A. The epithelial and mucosa and mucous tissue in integrity now in your lungs the epithelial cells and the mucous tissue function as a front line of defense against pathogen and bae invasion so when things are coming into you what you know you happen to be around someone and they sneeze let’s say they got the corona and they sneeze all over you . So what happens is these pathogens at frontline defense is your epithelial mucosa tissue now vitamin A bullet number two plays a crucial role in the morphological formation of the epithelium epithelial keratinization stratification differentiation and functional maturation of the epithelial cells.

What does that mean okay in English what that means is that vitamin A is literally used to create the wall. When talking about vitamin A think about it as the thing that produces cytokeratins which are the building blocks protecting your cell walls and they they’re the ones who provide the border and in the epithelial cells of your lungs they’re the ones who create the proper infrastructure so your body doesn’t get attacked by these pathogens.

So that’s like the first defense system the other piece you understand is that vitamin A is an integral part of the mucus layer of both the respiratory tract and your intestines. If you look at your grunt gut and your respiratory tract vitamin A is an integral part of that mucus layer and vitamin A promotes a mucus secretion it improves antigen nonspecific immunity of your innate and adaptive system so vitamin A is by the way it’s a hormone.

It’s not just a vitamin it has an amazing effect on really supporting your entire immune system and this is something that you need to take away from this.

Epithelial cells here these are the cells and you see this beautiful redstuff in the diagram this is the really the keratinization that takes place or the cytokine Wahlstrom thats what vitamin A does to protect yourselves.

Now vitamin A deficiency leads to scarring of these epithelial cells and the scarred and dysfunctional epithelial cells are unable to exert you know a barrier function to really support your innate immune system.

What that means is if you don’t have enough vitamin A you don’t get these beautiful walls and your cells actually starts carring so they’re not really able to protect themselves from these viruses and the other key things we want to share with you are the vitamin A promotes a proliferation to regulate apoptosis thisis proper cell death of cells that you don’t want to have and vitamin A deficiency leads to defect in the Tcells.

Those T cells are the ones in the adaptive immune system and vitamin A is essential for proper development differentiation of those macrophages you know it’s the type of the innate cells and vitamin A plays a regulatory role in the differentiation stage of the natural killer T cells and the down-regulating the expression of these if’ n gamma .

Vitamin A is going to protect your cell walls but more importantly it’s also going to make sure that your immune system is properly modulated and it down regulates those cytokines that will cause a cytokine storm that goes and attacks you.

So this is why vitamin A is critical this is why you want your thyroid working properly and all of those things are possible and you can easily do this on your own start eating good foods start eating the vegetables start making sure your thyroid is working properly and it’s sort of insane that the doctors dont first recommend first line of defense is why not test your vitamin A levels firstline if they really want to protect your immune. Are they testing your vitamin A levels that’s what they should be asking. You know vitamin A can really regulate the entire adaptive and immune system response.

Another amazing nutrient from the Sun called vitamin D which produces chemicals which are antiviral. They’re things that go and protect our body that’s why the Sun is an amazing healer , that’s why most cultures they paid homage to the Sun gods because it is a healer.

So vitamin A, vitamin D and you know take your vitamin C and we can add more we need to build our immunity .

Understanding The Viral Attack

We want to talk a little bit about the viral infection itself and immunity for that we’re going to draw out a little bit of a schematic here and how this happens so the first thing that happens is of course you have this virus particle which will draw as stars and these stars are outside the body so this could be an airway this could be inside the GI tract etc etc so this virus goes in and latches on to cells receptors and it causes these cells to become infected with the virus and of course the virus takes over the machinery of the cells and it causes it to make more of it and proteins and so these cells will be coated with these proteins on the outside and of course more particles are made these cells explode and they release more and more of these virus particles so what is going on at this point is you’ve got here on the blood side you’ve got things called cells which are blood cells and one of those cells is called an antigen presenting cell APC and so these cells start to go in and extravasated blood into the

tissue and they’re able to recognize these cells that are abnormal because of these abnormal proteins on the surface so these antigen presenting cells envelop and destroy these virally infected cells so let’s show a little bit more of a close-up of how that happens so we have this antigen presenting cell and inside the antigen presenting cell is the cell that is infected with virus and it’s got virus particles on it and so what’s very important what this antigen presenting cell does is it presents the antigen so here is the antigen presented on the outside of that cell this is the most important thing that the antigen presenting cell can do because what it then does is it meets up with something called a th one response or a cd positive cell and this cell here is the mastermind behind your cellular mediated immunity because this antigen here will latch on to this cd positive th one cell and it will release il- which is a chemical that comes from the antigen presenting cell that stimulates the cell to go and fight anything that looks like this on it that antigen and so there’s major responses that can occur number one is that these th one cd cells will then stimulate another type of T cell called the cd cells and those are killer cells and they go out and all they do they will kill any cell that has those antigens on it that’s a very important thing and the way that that happens is it has little proteins on the surface that will recognize this and cause docking to occur so you want that connection to be very very tight another thing that this th one can do is it can stimulate in the blood and tissue B cells and these B cells will produce antibodies that look like this and these antibodies will bind to these antigens and neutralize them so this really is immunity and this is the key that allows you to survive a viral infection let me be very clear about this this is probably one of the most important things that you can have going for you when you have a viral infection this is what determines whether or not you get admitted to the floor or whether or not you go to the intensive care unit because if this reaction doesn’t occur correctly and this immunity doesn’t get on top of the viruses quickly and limit them kind of quarantine in this then you get wide viral infections all over the body and the amount of infection causes more immunity which causes more inflammation and that’s why people die and so while the best way to prevent you from ending up having something bad happen from corona virus is to avoid getting the virus in the first place if you do get corona virus you want your immune system working perfectly and wouldn’t it be nice if there was something that we could do to enhance this il- response to enhance the ability of this binding to occur to enhance the ability of cd killer cells to bind their targets and to destroy to enhance the ability of th one cd cells to create and stimulate actually these B cells to make antibodies well there actually is something that we can do that can enhance this number one it’s not a drug number two it’s absolutely free there’s no money involved number three you can do it anywhere and I’m sure by this point you’re probably saying what possibly could this be and you pulling my leg on this this is probably one of the biggest things that you can do to protect yourself from this viral infection causing a problem or any other viral infection and there are absolutely no side effects to it and the answer is sleep that’s right sleep and enough of it greatly enhances the ability of the antigen-presenting cell binding to the th and promoting il- sleep also prevents the breaking up of this binding site with cd killer cells with the antigen and we’ll show you the research that’s done this I have peer reviewed papers in extensive research over the last years that sleep has a tremendous effect on your immune response against viruses I will show you a paper here here we have on the left side a cytotoxic T cell this is the cd cells this of the cells that kill and here we have an infected cell with either CMV or EBV in the paper so what they showed was that there is a

g-protein receptor here on the cell and when it is activated by either isoproterenol epinephrine or norepinephrine these are hormones typically that are elevated in wakefulness that this wakefulness hormones would activate this receptor in the killer T cells and it would cause a inhibition of these beta to integrand proteins that allow binding to these infected cells and destruction and so the opposite was true when the patients were sleeping because these hormones were at very low levels that prevented the inhibition of this GA s G protein which caused better binding and more effective killing of these infected cells so do you know how much sleep in adult in the United States should be getting according to the recommendations and you can look this up at the CDC they should be getting between & hours a night do you know how many people actually get at least hours of sleep per night about % that means there’s about to % of us that are getting less than hours a night these are the people that are at the highest risk for the effects sleep deprivation and these are exactly the same conditions that a lot of our health care workers in the United States are under these are physicians these are nurses these are respiratory therapists who are chronically sleep-deprived because of shifts because of working at night and these are the ones that are gonna be on the front line dealing with this virus think about a lot of the physicians that are working in China right now and all of this is to the detriment of their immune system at the beginning of the night when you go to sleep normally let’s say around p.m. the first thing that occurs is that you should be having more slow-wave sleep at the beginning of the night and towards the end of the night more REM sleep well they’re starting to see that slow-wave sleep is integral in the production of growth hormone and growth hormone has tremendous effects on immunity and this is especially involved as the papers will show that I’ll upload to the description in the secretion of il- elv which is what we recall is the thing that causes the antigen-presenting cell to stimulate the th response with the cd cells so that’s tied to slow-wave sleep this is the sleep right here that occurs generally speaking between p.m. and a.m. in the morning and this is the sleep that we cut off the most by going to bed late and so we’re losing out on growth hormone and our immunity stinks because of it I want you to think what’s happened to our ability to sleep over the last number of decades so this is when we would normally go to sleep around to p.m. and occasionally people would wake up in the middle of the night and be awake for a little bit and then they would get up again in the morning around to a.m. this is the time that we used to have for sleeping and how much time is that so for about to would be about eight hours of sleep according to the CDC and most of the research plenty of time but what’s happened because we’ve moved away from an agrarian society to more of a urban society we’ve had to push this back because we have to get up earlier because of traffic and what’s happening is we’re living out in the suburbs we’re living it further out and all the jobs are in the cities and so there’s traffic and so sleep has taken a big toll there and we’re not able to get as much sleep but on the other side there’s also been a push and why is that because of electricity and the other thing is electronics so think about iPads smartphones in general years ago television movies internet all of those sorts of things and so the key here though is all of this is light that’s stimulating the eyes and when you stimulate the eyes with bright light it pushes your circadian rhythm and delays it and so what you’re losing out on is sleep there and so what’s happened is we’ve gone from society where we were getting eight hours of sleep before and now getting five to six hours of sleep that is going to translate into decreased immunity so the question is how can we get this back because I believe this is one of the things that we can do in the face of this coronavirus that we don’t have to ration we don’t have to worry about do we have enough of this to go around for everybody in an epidemic because this is something that’s available to everybody is getting plenty of sleep to help with immunity in addition to me being a pulmonary and critical care specialist that takes care of the unfortunate effects of the virus with people with a RDS and on the ventilator I also happen to be a sleep specialist and I know that there’s a lot of people out there that have problems with sleeping some have insomnia some have sleep apnea some have a number of these things and for each person it might be an individual thing but there are some basic things that we can do to improve our sleep and so for the next couple of updates we’re going to talk a lot about coronavirus or as it’s called now SARS Cove or cove at but we’re also going to talk about practical things that we can all do as individuals to help bolster our immunity and be prepared for anything that might come thanks for joining u English

welcome to another med cram kovat updates you can see the numbers here they are starting to exceed that of mainland China when we look globally what I wanted to get to today is something that a lot of you have

commented on and that is the receptor for the SARS cough — virus that causes kovat and that is the ACE receptor the h receptor is how the virus gets into the cell it’s the doorway and it’s more than just the doorway and today we’re going to be talking about exactly what the ACE receptor is and what it’s involved in and why that matters as we’ve talked before outside of the cell or on the surface of the cell there is a receptor for the SARS cub to virus which is the thing that causes kovin which is the corona virus and so here we have the virus and it’s got these projections that make it look like rays of the Sun that’s why it’s called the corona virus this is SARS curve — this is corona virus here is the s protein that we’ve talked about and the receptor or this is on the surface of the cell specifically cells that are found in the lung the type to nuuma site it’s known as and also in the GI tract and this receptor is known as ace — and that’s really important for you to understand

ace — this is where the s protein docks and then there’s another protein called a serine protease which is also here in the membrane which helps to internalize this virus into the cell and it allows the messenger RNA which is in here to come in and infect the cell the key here though is this protein that is on the side of the cell is a stew and it’s exactly the same protein that was the receptor for the SARS of virus that was back in so the question is why is this such a problem well there is some animal data that’s angiotensin receptor blockers which is a very common type of high blood pressure medication and ACE inhibitors which is another common type of blood pressure medications can increase the concentration of these ACE receptors on the surface of the cell

so how do you know if you’re on an ARB or an ACE inhibitor typically a arby’s and in ta n so you might see this as losartan or Urbis Artin or candesartan these are all Tanz they are angiotensin receptor blockers we’re going to talk more about what they do so if it’s true that they could increase ace levels it seems like it will be common sense that if you have more ace receptors on the surface of your cell now you’ve got more entry points for the virus to infect your cell ACE inhibitors they typically end in pril so captopril and nalle’ prill and the list goes on those can also increase potentially your ace receptors and so what do we do with patients who are on ARVs and ACE inhibitors well it seems as though people have a higher mortality who have a history of hypertension and so this has led to a number of articles and a lot of social media to talk about well should we get off of our medications that we’re taking for high blood pressure so here is an article that was sent to the Lancet was published on March th and the question is are patients with hypertension and diabetes mellitus at risk for kovat infection and they talk about the incidence of cardiovascular diseases they talk about the Czar’s cuff virus and SARS — and the ace — protein which is the receptor for this and they talk about how ACE inhibitors and ARBs increase ace expression the increased expression of ace — would facilitate infection with kovat we therefore hypothesize that diabetes and hypertension treatment with ACE to stimulating drugs increases the risk of developing severe and fatal kovat now this is only a hypothesis they say here if this hypothesis were to be confirmed it would lead to a conflict regarding the treatment because ace reduces inflammation and has been suggested as a potential new therapy for inflammatory lung diseases cancer diabetes and hypertension a further aspect that should be investigated is the genetic predisposition for an increased risk of SARS cuff to infection which might have to do with ace polymorphisms they say and here finally they say we suggest that patients with cardiac diseases hypertension or diabetes who are treated with ACE to increasing drugs are at higher risk for severe kovat infection and therefore should be monitored for ace modulating medications such as ACE inhibitors or ARB s we did not find any evidence to suggest that anti hypertensive calcium channel blockers increase h expression or activity therefore these could be suitable alternative treatment in these patients here we have an article a correspondence to a very major journal which is raising an alarm on millions of patients who are on these medications and saying that they hypothesize that the patient could be at risk so obviously this is raised quite a stir and the question is is there any actual truth to this so let’s look and see what the response has been well here is the response from the European Society of Cardiology they say here because of social media related amplification these patients taking their high blood pressure medications have become increasingly concerned and in some cases stopped taking their ace or ARB medications this is what the official response is from the European Society for cardiology the speculation about the safety of ACE inhibitors or ARB treatment in relation to kovat does not have a scientific basis or evidence to support it indeed there is evidence from studies in animal suggesting that these medications might be rather protective against serious lung complications in patients with kovat infection but to date there is no data in humans the council on hypertension for the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful affective ACE inhibitors in ARB in the context of pandemic Ovid outbreak they strongly recommend that physicians and patients should continue treatment with their usual antihypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACE inhibitors or ARB s should be discontinued because of the kovat infection so what is it which one of these is correct to delve into the intricacies of that we’re gonna go into some molecular biology at some point we’ll get a little complicated but not too so bear with me as we go through a detailed instruction on exactly what is going on here with the SARS cub — virus and the renin-angiotensin system to understand this you first start off with a hormone called angiotensinogen and that is converted into angiotensin one which will abbreviate a t and that is done through a enzyme called renin that is produced by the kidney angiotensin is then converted into angiotensin and that is done in the lung by an enzyme called ace now ace is in the lung it does convert angiotensin to angiotensin and we can inhibit ace by giving someone an ACE inhibitor and these are the medication that end in prills so captopril and lisinopril etc etc so angiotensin is a powerful vasoconstrictor it also stimulates the adrenal gland to make aldosterone which has the action of lowering potassium and increasing sodium concentration and therefore increasing blood pressure angiotensin is a major dividing point because there’s two types of states that one can have in the body so we’ll call this the low state and we’ll call this the high state on the cell membrane is a component of proteins that are sitting out on top of the cell membrane and one of those is a stew and when there is not a lot of angiotensin ii around it is proposed angiotensin receptor or a trsits in the catalytic site of a stew now as it turns out angiotensin will be converted by a stew into angiotensin one and it’s very important for you understand angiotensin because angiotensin causes vasodilation and decreases inflammation that’s a good thing it’s also possible that you could put and have an angiotensin receptor blocker that would block this and that is an a RB so we’ve talked about angiotensin receptor blockers and we’ve talked about ACE inhibitors if you have high angiotensin this is the situation that you get you still have a Stu but the high levels of angiotensin cause the angiotensin receptor to come off of a Stu and when that happens when angiotensin interacts with angiotensin receptor the result of that is vasoconstriction increased blood pressure increased vascular permeability pulmonary edema and presumably a RDS furthermore when there’s high angiotensin hypothesis is that this opening in a stew allows for the coronavirus with its s protein to bind to a stew this binding here also requires something called a serine protease known as T M P r SS -now that can be inhibited with something called camest at mesylate and that is undergoing trials right now interestingly when you have high levels of this entire complex getting get degraded into lysosomes so let’s review quickly we’ve got angiotensinogen being converted to angiotensin by renin-angiotensin is converted to angiotensin by an ace enzyme ACE inhibitors can prevent that from happening if you have too much of angiotensin then what can happen is this angiotensin receptor blocker dissociates with ace and it gets activated to cause vasoconstriction increase blood pressure permeability pulmonary edema and a RDS that’s exactly what we don’t like to see in these situations in viral pneumonia however if there are low levels of angiotensin then what we see is that it gets metabolized by ace and that gets converted into a vasodilator called angiotensin comma also it looks as though a arby’s or angiotensin receptor blockers can somehow keep this complex together and keep that catalytic site blocked by the resident ATR angiotensin receptor and that can happen with angiotensin receptor blockers if it’s high however this dissociation occurs allowing the virus to potentially bind according to the hypothesis and that causes degradation so what do we see in people who have no ace if we take away all of their ace — as we’re shown here what happens well they’ve actually done this in mice they’re able to breed mice where they delete the gene responsible for making a stew they’re called knockouts double knockouts mean they take it both on the mother’s side and the father’s side so when the mouse is born it has no ace — whatsoever they’ve shown that these mice have a resistance to being infected with the virus because there’s no receptor but at the same time what they see in these knockout mice is that they have worse outcomes in viral pneumonia they have decreased cardiac contractility and they have increased levels of angiotensin which makes sense because it’s a stew which breaks down angiotensin ii when there is a low amount of it so these are in what we call ace to knock out mice and these are exactly the things that we’re seeing in patients who are infected with the corona virus what they saw in a mouse model of SARS cub from was that there were decreased levels of ace — in these viral models and they had normal ACE levels but there was less ace — Levels they also saw increased levels of angiotensin and when they gave these mouse models ARB and they gave them ace inhibitors this actually improved the outcomes and I’ll show you the links to those studies in the description below in a respiratory syncytial virus case they actually took recombinant ace — and gave it to these mouse models and they found that it improved outcomes so you can see according to the animal hypothesis that if you added an ACE inhibitor it would block this ACE enzyme making sure that this angiotensin was on the low side but what we may be seeing is that these angiotensin levels are actually on the high side and you would predict that if angiotensin levels were on the high side you would expect there would be aldosterone and low potassium and high blood pressure and that’s exactly what they saw in very very sick kovat patients is they were hypokalemic which means low potassium and the most critical of these had higher blood pressure before they crashed you can also see here how keeping somebody on a angiotensin receptor blocker according to this hypothesis may improve this kind of a situation leading to vasodilation and anti inflammation and I want to emphasize that while we have good data in mice when we look at humans we don’t see these kinds of things happening at least in the plasma in free-floating ace we don’t know what’s going on at the tissue level so it still may be happening and so the thing I want to stress here is that this is all hypothesis based on piecing together studies over the last years that they feel that this may be what’s happening and if you’re interested in this kind of research I’m going to put a bunch of links in the description below that link to the papers that talk about this but suffice to say that at this point to go out and say that we should be stopping people on their ACE inhibitors and stopping people in there on their ARVs in my humble expert opinion as much as you want to consider me an expert on this I would say that the jury is out and I believe I would come down on the side of the statement from the European Society for cardiology and saying we really don’t know at this point and we have some animal studies which actually show that they may be protective in this case there’s been a number of reports on the deaths in kovat that there are infractions or their cardiac contractility have been fine when they come into the hospital but over a couple of days of either viral myocarditis or because of this situation that we’re seeing here that they’re contractility has dropped significantly as we would expect when ace levels go down so this is something that needs to be addressed and we don’t know exactly what is going to happen until we have those studies the good news is according to what I have seen in the last couple of days there is research looking into starting patients on angiotensin receptor blockers or ARVs so that was a very long explanation over something that has come up very recently I think we should continue to delve into this receptor issue especially when it comes to talking about vaccines because ACE is going to play an extremely important role in the future of treatment of Coronavirus.


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