Of course, for every person that is moving towards a healthier more vibrant level of self awareness there is also a person that is struggling or being self destructive. One of the challenging parts about sheltering in place is the impact that it has had on people that are not safe, like people with chronic health concerns and people living with or affected by substance abuse, or other circumstances. These challenging situations, which perhaps should have been given greater consideration, have increased the overall mortality in BC over the last few months. So as I am sure many of us are thankful that the pandemic has had overall very low mortality in BC, my hope is that time is taken in our health agencies to identify and help protect other vulnerable and innocent populations that have been clearly affect by the past few months.

My major COVID-19 update is about testing. Health Canada has approved the first serological test for COVID-19  and Dr Henry has announced that serology testing will now be available to anyone that feels they may have have COVID-19, or would generally like to be tested (Survey here). I believe this step is critical in understanding the epidemiology of SARS-CoV-2, as reported in my last post. This is because the rtPCR testing being used to test for active viral infections has had, and likely continues to have, some problems with accuracy, including false positives. By comparing data from rtPCR testing to serological testing we will be able to better determine the number of true positive (and negative) cases in Canada. This will be our greatest chance to move forward from the pandemic without any further incidence, as “herd” immunity will be critical to our protection as a society. Further, if a high percentage of the population tests positive for COVID-19 this will reduce the need for mass vaccination.

With respect to Westcoast Integrative Health, the structure for re-opening to the public is actually less arduous than I expected although certainly in line with providing high level protection to our patients, as well as myself and my staff. No masks are necessary though, except by choice or for patients that are suspected of being infectious. Most importantly, in the “Restart” of BC we need to use common sense. Stay home or self isolate when ill, continue to wash your hands and do NOT cough or sneeze into open spaces. This will help prevent the spread of infectious diseases, including COVID-19. Remote appointments are still encouraged for clients that do not require in office care, which is actually the case across all medical forums. Most importantly though, if you or someone you know needs help, the “Restart” signifies that it is safe to reach out for help when we need it across all health forums.

What actually prompted this post, was a NEW genetic report that was shared by researchers (Mark and Jon) at Nutrahacker which suggests susceptibility risks for SARS-CoV-2 based on 11 cited studies related to a SNP (rs2070788) in the enzyme TMPRSS2.  TMPRSS2 is a enzyme protein that cleaves (cuts) ACE 2, which one study suggests makes this ACE 2 protein more susceptible to viral attack. So what does this mean ….

Well, a few weeks back I was thinking to myself, there has to be a functional reason (like all health concerns) for the increased susceptibility and severity of risk associated with SARS-CoV-2 in some people. Why else would the majority of peoples risk be negligible but the minority have a risk of infection with very serious adverse outcomes. Perhaps, others have been wondering the same thing. So one thought I had was general nutrition. Perhaps that has something to do with it, which I am sure it does in some ways.  Comorbidity and age also clearly play a role, which makes sense, as it would be hard to recover from overwhelming respiratory failure. But what about those 20 or 30 year olds that seemingly have no significant risk factors. So … like most health concerns, I thought that there must likely be a genetic variable playing a role. Thank you Mark and Jon for outlining one of these genetic variables.

In this report, there is also a reference to prevention and treatment, for susceptible people. One study referencing that nicotine affects outcomes negatively, which makes sense, while the other outlining chloroquine as a valid therapeutic option. Of course the language used in these reports is not supported by a high level of commitment, as there are still a lot of unknowns, and likely a lot more to the equation than just this SNP in TMPRSS2, but I was happy to make a little more sense of the epidemiology.

There is also a trial starting in Canada using the gout and pericarditis medication colchicine to help prevent the severity of symptoms for sufferers of COVID-19. Colchicine is also being studied in Greece and perhaps Canada is piggy backing off of this research with trials running concurrently in Quebec and Vancouver. The nice thing about colchicine is that it is 100% natural, dervived from the autumn crocus flower bulb! Participation is voluntary and side effects can be significant. Side effects include mostly dose related toxicity and common gastrointestinal symptoms. Mechanisms for the drug is the disruption in cytoskeletal functions by inhibiting β-tubulin polymerization into microtubules, preventing activation, degranulation, and migration of neutrophils associated with mediating some gout symptoms. In familial Mediterranean fever, cochicine is thought to interfere with intracellular assembly of the inflammasome complex present in neutrophils and monocytes that mediate activation of interleukin-1β.

https://www.ncbi.nlm.nih.gov/pubmed/?term=cochicine+and+CoVID-19

So what is going to happen next. Well, I for one, am hopefully that SARS-CoV-2 is seasonal, suggesting that as we head into summer and early fall there will be a dramatic drop in risk of transmission and case burden, but this has yet to be definitively determined. I am also anticipating that some degree of social distancing and hygiene guidelines, including the wide spread use of masks, will continue into our future. If I had the skills I would be starting a trendy new cotton mask business … as I am going to predict this will be the newest accessory, right up there with watches and sunglasses.

If anyone is following the testing for COVID-19, then they would know that it is a fairly sad state of affairs, with both false positives and false negatives being pretty unacceptable and all over the map. Further, the FDA has approved wide spread testing across laboratories in the United States. In fact, many of the testing companies that I use in the US are providing the infamous reverse transcription Polymerase Chain Reaction (rtPCR) nasal swab testing that is fairly standardized across the world at this time. Generally PCR testing boosts high specificity and sensitivity (accuracy) to detect known infections, but apparently this is not the case for COVID-19 as there seems to be a wide array of reported false positives and negatives with testing. So what does this mean? Well it is hard to really know what the epidemiology of a disease is, when the testing being relied on has the potential to be inaccurate.

In summary, Dr Henry, BC’s Provincial Health Officer has deemed Naturopathic Medicine an essential service in British Columbia and with the current statistical positive rates reducing here in BC, I am cautiously heading back to the office one day per week. In-office consultation, with respect to The College of Naturopathic Physicians of BC (CNPBC) guidelines, should be confined to situations in which a client is at risk of imminent or serious harm and alternative care is not available. Since I do see patients that meet these criteria, I would be happy to consider consulting with patients that need this level of care.  As a medical professional, sterile techniques are very important to me. I will be wearing gloves, mask and eye protection in the office and sanitizing with Health Canada approved sanitation methods between patients. As an additional precaution for the months to come, for those patients requiring in office visits, I will be providing gloves and masks if they do not have their own. At this time, I still strongly encourage remote consultations to those who are comfortable with telemedicine. And for other businesses? Most will need to adapt to the new norm, until such a time that 70 to 90% of our population has immunity to the noval coronavirus of 2019. Support local business, where ever possible!!

As a small business owner I can say first hand that the struggles many Canadians face right now are very real, and sadly most Canadians cannot afford to hoard. Further, there is really no need to hoard supplies because thankfully Canadians have rallied together as a whole, making great financial sacrifices to reduce the rate of viral spread, and we are already seeing the curve levelling off in Asia from similar efforts around the world. So one reality is that if everyone uses this time to not only be mindful about their own needs but also to be conscious about the needs of others in their communities then perhaps this “stay-cation” can be an incredible and painless learning experience for all of us. We need to be compassionate towards others and consider this an opportunity to take better care of ourselves and our planet (Reference Bill and Ted). Spend a few minutes considering how spoiled we are to live in such an amazing country, where 2 meters of distance between each other is the norm, and then perhaps this crisis can teach us and help us evolve. Also consider buying local and supporting small businesses in your communities so that they can hopefully survive this crisis. Most businesses on the Sunshine Coast are offering delivery or pick up services! I am working remotely from home.

That being said, people of greater age or suffering with chronic health concerns make up a majority of my patients and the safety of my patients is paramount to me. In an effort to try and flatten the exposure curve I feel that it is a social responsibility to only offer remote consultations to clients starting Monday March 23rd for 1 or 2 weeks pending public health announcements on the trajectory of the virus. This will also allow Tania (my staff) to work from home. So following this week (March 16th and 17th), we ask that all non-critical pending lab test collections be postponed and all appointments be booked remotely. I will be consulting via secure video or telephone from my Roberts Creek clinic on the Sunshine Coast for anyone that needs my support.

With respect to prevention of any viral infection, proper hygiene (hand washing and avoiding contact with pretty much anything) along with rest, good hydration, nutrition and keeping stress levels low is a start. Chicken stock (made from scratch) is a great way to achieve 3 of these recommendations and perhaps the satisfying nature of good chicken stock might even check off box number four. For people that are at risk, additional vitamin C, zinc, probiotics and vitamin D are excellent for supporting immunity, but make sure to leave some for everyone! Also, don’t forget to do your deep breathing!

Thank you for your understanding. Please feel free to email us if you have any questions and note that the above may chance without notice.

This recent meta-analysis and randomized controlled trial outlines some of potential benefits of these agents on cardiovascular risk and diabetes. The down side of these medications are their expense as well as the requirement for subcutaneous injection, while the up sides seem to be getting more and more appealing. In the next year, pending on whether my insurance covers these medications, I am going to start a trial on eradicating senescent cells in my body using liraglutide, while continuing my intermittent fasting regime 4 to 5 days per week. I am also hoping to start another biological agent this year called Repatha as a trial to lower my lipoprotein (a) levels. Stay tuned.

Arriving at the brand new airport in Split, right away you can tell you are in Europe by the overpowering smell of burning tobacco. Split is a stunning and bustling city of 350000 and the second largest in the country of Croatia. When you arrive here, although amazing to see, my sense was to “get out of town” as quickly as possible as the energy is very much that of a larger city. So we jumped into our rental van and headed for the ferry.

“Twinning” my life in Vancouver, the drive from Split airport to the Jadrolinija ferry terminal in the heart of Split was in many ways similar to my drive from North Vancouver to Horseshoe Bay ferry terminal, only envision a much more reckless and chaotic commute where people don’t seem to like staying in their own lane of traffic. The ferry commute to the Island of Brac was also eerily similar to being on the ferry home to the Sunshine Coast, only once again complete chaos with pedestrian loading and car loading and offloading occurring at the same time and of course the chain smoking. In fact, the Jadrolinija ferry experience makes the BC Ferries look good, but there is also a sort of charm to the flow of things in Croatia.

Arriving in the largest town on the island, Supetar, our destination was roughly 50 kms across the island to the small fishing village of Sumartin. With a population of only 500 people, right away you get the feel for life in Croatia; relaxed, as long as you don’t disturb the peace. And thanks to my father in law, our accommodations were world class and could not have been more idealistic for my underlying desire to integrate into the Mediterranean lifestyle as quickly as possible. Located right across a tiny access road from a semi-private little beach with individual guest suites, our place was topped off with an outdoor kitchen, eating area and infinity pool. Because Brac is famous for white stone, apparently the very same that the White House in Washington DC was built from, all of the houses are made from beautiful stone and dot the steep terrain surrounding the sea.

Our days in Croatia, as one can hopefully imagine when travelling with our 4 month old son Arlo, were focused almost entirely on sleeping, reading (Being Moral and A Gentleman in Moscow), exercising, and of course eating. And the food, being one of my main objectives to discover on this trip, was far from disappointing. Breakfast in the “Med” is mostly carbohydrates though, so 80% of the time I opted for intermittent fasting and a 1 hour mountain bike ride through the rugged hills of olive trees that cover the south eastern part of the island. As part of my ride, I would bike into town to gather supplies at the everyday open-air fruit and vegetable market, the tiny grocery store and occasionally the butcher. These outings were cherished for some of the much needed self-reflection time, essential to a good vacation, and to really provided a sense of what living on the island of Brac would be like.

People in Croatia seem to be early to bed and early to rise, much like Emily and I at home, so adapting wasn’t hard. And its no wonder because of the arid and generally hot climate, people are up early maintaining their land (or at their jobs) when its cool, and swimming, eating and otherwise relaxing in the afternoon when it is hot.  In general, especially on the island where supplies are more limited, everyone seems to maintain some kind of permaculture set up, growing citrus, grapes, olives, herbs, veggies and other fruits. A true homesteading culture, most  families also seem to fish or hunt, on top of maintaining their garden plots. The other amazing thing that I need to mention, is that in Croatia, the elderly are generally taken care of by the community, so its common for neighbours to hangout with each other, regardless of age, and share or trade what they have.

So enough about the culture, lets get into the food. In Croatia, food is amazing and SO inexpensive! Fruits and veggies are almost always local organic and cost pennies on our dollar. Olives literally grow on trees and most towns have an olive oil processing facility that makes 100% pure organic olive oil. And dairy is generally less common in the form of cows milk and cheese, being replaced with incredible cheeses made from goat or sheep milk. Although bread is a staple food subsidized by the government, like in most Mediterranean cultures it is not the focus of the lunch or dinner meal so sandwiches generally do not exist. Also, being on the ocean, in general the Dalmatian diet is centred around seafood and wow is the seafood ever amazing, and once again pennies on the dollar. Scampies, shrimp, octopus, muscles, and many types of fish are found everywhere, and often can be purchased right of the boat.

On this trip, like most trips I have taken to Europe, the main dining experience revolved around a 1 pm to 2 pm lunch. And in Croatia it was generally a lunch of either “Peka” or seafood in various forms. But before I get into details, it is important to consider the hours of planning and preparation that can go into a simple meal. With a seafood meal, it starts with a 6 or 7 am trip to the open air fish market 50 kms away or a 5 or 6 am adventure to the local fishermen, if anything is available. With lamb, you need to go to the lambing town and with chicken … “I know a guy”. So generally everything revolves around protein … which I can relate to. The veggie portion of meals is almost always the same, potatoes, zucchini, peppers, onions and garlic in a soup of pure olive oil and tomato and cucumber salads on the side. So once everything was prepped, my job was to start the cooking fire in the outdoor fire place that everyone seems to have.

Like any traditional cooking fire, the objective is coals not ash, so typically a hard wood is used for the best results. Once the charcoal is sufficient, larger chunks are removed and placed into a second fire for later, while a nice consistent pile of hots coals remains. The peka is cooked in a 30 to 40 lb cast iron pot with a lid, so think old school “Instapot”, where the ingredients are loaded into the pot, dosed with olive oil, then the lid is placed on and an olive oil seal is created so the pot does not leak steam. The pot is then placed on a brick surface and surrounded in coals over the top of the pot and the sides. The initial cooking takes  roughly 30 minutes, regardless of the content of the pot. After that initial cook the lid is removed and the contents are given and poke and a seasoning and then cooked again until done. So a typical meal from beginning to end takes about 3 hours, give or take.

The “Peka”, was by far my favourite thing to eat in Croatia, and certainly one of the top 5 things I have eaten ever. I guess the contents are nothing special, but the way the Peka seems to preserve the flavours of the foods that it embraces makes the meal taste like nothing you have eaten before. And with the pure olive oil and fall off the bone goodness, without even the slightest hint of being over cooked, Peka is true testament to the Croatian culture. So, needless to say that I left Croatia knowing I needed to build my own outdoor oven, and bring Peka home to Canada!

This 162 000 plus person retrospective (looking backwards) cohort (at a group) study answers a long standing medical question about “optimal” thyroid function and provides reassuring evidence that the functional medicine reference ranges for TSH of around 2.0 mlU/L clearly reduces many important health related outcomes, including all cause mortality, atrial fibrillation, ischaemic heart disease, heart failure, stroke/transient ischaemic attack, fractures, and frailty risks.

Without being insulting, this is a perfect example of why it is important to consider a more integrative or functional medicine approach to your health care as the average medical professional will typically only consider TSH to be a concern when it is outside the standard reference range and often greater than 10 mlU/L, which is exactly what this large study says can cause clear serious long term health concerns.

Although, it is important to note that not everyone has a thyroid problem, it is fairly common to see suboptimal or subclinical hypothyroidism, which may include obvious symptoms like slow metabolism, sluggish bowel function, poor circulation (hair loss and fatigue), slow heart rate and water retention. Typically subclinical or functional hypothyroidism is the result of stress, however autoimmune causes should be ruled out, which is why it is important to get a complete thyroid panel including TSH, free T3, free T4, reverse T3, TPO antibodies, and anti-thyroglobulin antibodies.

One final note is that life long medication is not always the answer. One needs to consider gastrointestinal microbiology, food intolerance and stress/sex hormone imbalances as being a part of the solution for Hashimoto’s hypothyroidism and stress reduction to address functional hypothyroid concerns.