The Antibiotic Problem: What 23 Extra Years of Life Cost Your Gut

WEBVTT

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Have we become too comfortable prescribing antibiotics?

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Yeah. Antibiotics

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added about 23 years to people's lives.

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Wow.

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So that's the estimation.

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Welcome to Next Phase Human,

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where medicine meets performance and science meets longevity.

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I'm your host, Dr Rasham Sandhu, and with me today is Dr Rasha

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Quran,

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infectious disease specialist at Kern Medical Center and at UCLA,

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and director of Infectious Disease Fellowship Program.

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We have lots to talk about, about antibiotics, the overuse,

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the effect on gut microbiome on that, about

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COVID-19 a little bit, how your nutrition will affect your

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infection risk, and how your hormones affect your infection risk.

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So lots of fun stuff to talk about. Let's dive in.

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Thank you, Dr Quran, for joining.

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Thank you for having me, Dr Sandhu.

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So first of all, a lot of our viewers may not know what an

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infectious disease specialist does day-to-day.

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So what drove you to become an infectious disease specialist, and what does

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your day look like on a day-to-day basis?

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Yeah. Infectious diseases, the title of the specialty is a

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bit of a misnomer, and it

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implies that I treat infections that spread from one person to the other.

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But the majority of the infections I treat are not

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transmittable from one to the other, and that's why

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they're not all communicable diseases.

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Some happen when microbes move from where they belong to where they

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don't belong from within the body.

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So what got me into this was really an excellent role

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model, and a career role model, and a mentor.

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His name is Royce Johnson. He happened to be my chair

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of Department of Medicine when I was a resident, and I fell in love

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with the specialty since then, and he sponsored me and recommended me

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to the fellowship programs that I wanted.

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And

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so I did my residency at UCI, and I never looked back

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since then, and I fell in love with it.

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Well, we are all lucky to have you. As I always say, you're one of the smartest

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people I've known.

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Oh, thank you. I'll pay you later.

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So why should healthy people who are living

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normally a good, clean, healthy life, should care about infectious

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disease?

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So infectious diseases do not necessarily only affect

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people who do not eat healthy or live a healthy life

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or

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have good hygiene.

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Some infections affect people based on genetics, believe it or

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not, like valley fever, for example.

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The likelihood of it spreading in someone's body and causing a severe

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infection versus not is not all predicated on

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the immunity itself. It has a lot to do with genetics.

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So really, there is nobody who is completely immune from

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infections.

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So

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we'll dive into it more, but just a quick follow-up on that.

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You mentioned that the valley fever spreading into your body can be affected by

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genetics.

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Now,

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is it likely that if your parents or your brother or sister had

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bad valley fever, you're more likely to have bad valley fever?

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Is that what that means?

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That's a very good question.

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So we are actively doing research to discover

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the mutations or genetic susceptibilities right now at Kern

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Medical in collaboration with our colleagues at

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UCLA.

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So it's not that much of a straightforward

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relationship,

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but that can happen and where it can cluster in certain

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families.

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But for the most part, you'll see someone who has a severe disease

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and their family members are not, and it's not fully

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elucidated yet.

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But there may be a component-

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Yes

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... of what your genetics are like.

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Yes. Genetics and ancestry

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as well.

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Got it.

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So modern life.

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Infectious disease used to be a big part of how people

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died back 100 years ago.

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Has modern life made us healthier

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or more susceptible?

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So it depends on what you mean by healthier.

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If you look at the lifespan,

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comparing what it is now compared with the turn

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of the

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20th century, it almost doubled. So it went from 50

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to close to 80, I think, something like that.

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So our lifespan increased.

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Now, the quality of life,

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one can argue, are we healthier or not?

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Looking back at the mortality rates in the beginning of the

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1900s,

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it appears that most of the deaths were during childhood.

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So really, whoever survived that early childhood

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period would live a healthy, long life into their 60s

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and 70s.

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So they obviously had a healthy life, and with modern

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times come

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risk factors for infections,

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such as the diseases of the time, like diabetes, which predisposes people for

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infections. And so it's not a straightforward

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question to answer, but I would say,

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generally speaking,

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I think we are healthy. Now, if you think about the

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lifespan, and how much longer people live,

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a lot of the times they didn't live long enough in the past to experience the

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diseases that we're having when we age.

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The lifestyle diseases.

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Yes, the lifestyle diseases. So, I think it's complicated,

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but certainly with modern

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lifestyles comes more susceptibility to diseases.

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We have to pay attention to them and

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counteract that.

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And a big part of that is, of course, antibiotics.

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That journey has been

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Pretty impressive, to say the least.

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But we're at a point in medicine where,

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have we become too comfortable prescribing antibiotics?

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Yeah. Antibiotics

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added about 23 years to people's lives.

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Wow.

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That's the estimation.

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So

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they are important, and they save a lot of lives, millions and hundreds of millions

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of lives. But we do have a problem nowadays

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with over-prescribing of antibiotics, and it's even worse in other

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countries other than the United States.

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We have some control here. But even with this

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control, there's a lot of pressure on providers to prescribe

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and issues within the medical system where antibiotics

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do tend to be prescribed

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more than they should be.

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Does every cold need a Z-Pak?

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That's one of the pet peeves now, huh?

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Right.

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No. Obviously most of upper respiratory tract infections are

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caused by viruses, and antibiotics will not cure

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viruses. So

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that's one of the biggest issues.

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So

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most of people with upper respiratory tract symptoms, presuming they are

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otherwise healthy, would not benefit from antibiotics.

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Correct.

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That's a fair statement?

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Correct.

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And in general, for viral illnesses, they don't really do anything,

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correct?

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Uh-

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The antibiotics

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... the antibiotics will not affect a viral infection.

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Antibacterial antibiotics will not affect a viral

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infection. Antivirals might, but not all viruses have treatment.

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And

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we talked a little bit about the overuse of antibiotics.

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What are some of the issues we are facing with that?

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So it starts with the expectations from

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people when they get sick nowadays.

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For the longest time, too, they would go to the doctor or the practitioner or the

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provider expecting something to be done, and I think there's

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pressure on the providers to prescribe something,

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even though studies have shown that

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education and reassurance can be satisfactory to the patient.

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But a lot of people do feel that pressure, and I think it's not as bad as it used

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to be in the community. And with the advent

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of the

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rapid testing that we have nowadays, where you can check someone for

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influenza, group B streptococcal infection,

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on the spot, that helped withhold antibiotic

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prescriptions, especially in children.

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So that's one of the issues, but there are many

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others, and some of them have to do with the specific

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situations like here with valley fever.

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Valley fever

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manifests like the flu initially, fever, chills,

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and then cough, and then pneumonia. So it is a type of pneumonia.

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And one third of community-acquired pneumonia in an

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area like ours is valley fever. But it's

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very rare that this gets diagnosed the first time

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the person goes to the ED, because it's confusing, and it looks

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exactly like bacterial pneumonia.

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So patients with valley fever, on average, get two to

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three courses of antibiotics before they actually get

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diagnosed and

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then take the antifungal medications that treat valley

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fever. So that's another way where,

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if we diagnose valley fever early, we would save all these antibiotic prescriptions

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and treat the patient sooner.

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And that's more common for the area that we live in, where valley fever is

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endemic-

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Yes

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... in the Central Valley of California.

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But my understanding is, with the changing climate patterns, we are seeing

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it beyond Central Valley areas, too. Is that true?

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Yes. It is. It's common in Arizona and

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the Central Valley in California and some Central and South American countries.

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And then the surrounding

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states such as Texas,

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New Mexico, Nevada, et cetera. But yes,

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we are seeing more cases now outside the zone

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due to the changing weather patterns.

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And

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just kind of pivoting back to when you mentioned for the common

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cold check, the

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test for strep and whatnot. So if, as a parent,

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someone brings their kid, and most common scenario is either to primary care or

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their urgent care, local urgent care, with cough, cold

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symptoms, what are some of the things they would ask

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or reasonably expect to be done

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from an infectious disease standpoint?

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Okay, do this, this, and this test, and this is what parents should be asking.

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So a thorough history and physical examination, that's always the base.

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Examine the patient. Look at them.

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Look at their vital signs.

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It is tough to distinguish viral from bacterial infection just by

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examination, though. So that makes it challenging

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to pinpoint whether it's a virus or not without testing, really.

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So I would say if testing is available for the

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strep throat tests or influenza

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testing, COVID-19 testing, if it's available, I would

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say yes, ask for it.

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So those three would be the base that you would start with?

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Yes.

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Fair enough. And then generally, if all that is negative-

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There's no need for antibiotic

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... is it reasonable to hold off on antibiotic and see?

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Yeah. There's no need for antibiotics.

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Perfect. And

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are we approaching a future where infections get more and more difficult to

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treat?

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Yes. They are getting more difficult to treat, in part because of

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antibiotic resistance.

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And another part is people are living longer

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with more immune-compromising conditions like

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transplantation and autoimmune disease

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treatment and

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cancer treatments are advancing, so

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people's immune systems are not the same like before.

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They're not homogenous as they used to be.

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And so you can get really challenging infections.

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They are more difficult to treat now.

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There's almost subspecialties in infectious

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disease now, where some people specialize in

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solid organ transplantation

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or hematologic

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transplantation or orthopedic infections, et cetera,

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because they're getting more complicated.

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And in terms of those infections that you treat, what are some

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of the organisms that you really, as an infectious disease specialist, worry about

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in the hospital or in the community?

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You

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hear it all about patients talking about MRSA, and that's the

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dreaded word. So what is that, actually, and why should

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people in the community worry about?

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MRSA,

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it's a staph infection. Staphylococcus is a bacteria that we all

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can carry on our skin. But there are strains that

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happen to be more resistant to antibiotics when they do

264
00:13:19.684 --> 00:13:21.984
cause an infection or get inside the body,

265
00:13:22.804 --> 00:13:24.684
cause pneumonia or skin infection.

266
00:13:24.984 --> 00:13:28.924
These new strains are more aggressive, and

267
00:13:28.944 --> 00:13:31.244
so they cause infections more readily.

268
00:13:31.464 --> 00:13:35.304
And also, they are more resistant to the antibiotics, and they require

269
00:13:35.324 --> 00:13:38.244
special advanced antibiotics to treat them.

270
00:13:39.124 --> 00:13:43.074
And so the original staph aureus or staph bacteria used to be called

271
00:13:43.124 --> 00:13:46.964
methicillin-sensitive staph aureus, and then MRSA is methicillin-resistant

272
00:13:47.064 --> 00:13:47.704
staph aureus.

273
00:13:48.524 --> 00:13:52.514
That's one of the challenges. And even the antibiotics that we have been using

274
00:13:52.514 --> 00:13:53.804
for that MRSA,

275
00:13:55.544 --> 00:13:57.164
there's small

276
00:13:58.384 --> 00:14:01.754
amounts of resistance that's building up in it.

277
00:14:01.784 --> 00:14:03.664
Even the ones that you use now for that?

278
00:14:03.964 --> 00:14:04.684
Yes.

279
00:14:05.064 --> 00:14:07.684
And that's likely due to overuse of antibiotics?

280
00:14:08.124 --> 00:14:11.824
That's likely due to the use of antibiotics and certain

281
00:14:11.884 --> 00:14:13.314
host factors as well.

282
00:14:14.664 --> 00:14:16.254
So it's the pressure of antibiotics

283
00:14:17.284 --> 00:14:20.194
while the bacteria is replicating that produces resistance.

284
00:14:20.804 --> 00:14:24.784
So someone who has an infection, and we're not able to surgically

285
00:14:24.804 --> 00:14:28.584
clear the majority of it and giving antibiotics at the same time,

286
00:14:28.664 --> 00:14:32.104
that's the most difficult and most conducive to resistance

287
00:14:32.884 --> 00:14:35.724
occurring, is when the infection source is not removed,

288
00:14:36.564 --> 00:14:37.764
but we're giving antibiotics.

289
00:14:38.444 --> 00:14:42.364
So should a normal person going down the street worry about MRSA?

290
00:14:43.944 --> 00:14:45.464
Yeah, you can get MRSA from the gym.

291
00:14:46.204 --> 00:14:46.444
Okay.

292
00:14:47.104 --> 00:14:48.324
From any

293
00:14:49.624 --> 00:14:53.504
skin-on-skin contact with other people, or short period of time

294
00:14:53.544 --> 00:14:55.924
between someone else touching the same item.

295
00:14:56.664 --> 00:14:58.984
So in the gym, people sit on the same

296
00:14:59.844 --> 00:15:00.164
seats,

297
00:15:01.024 --> 00:15:02.044
and it touches their skin.

298
00:15:03.004 --> 00:15:05.744
You really want to disinfect the seat before using it.

299
00:15:08.124 --> 00:15:11.304
Doorknobs or taking care of people or touching someone.

300
00:15:12.344 --> 00:15:14.994
So it doesn't live in the environment for too long.

301
00:15:15.344 --> 00:15:18.844
Usually, four hours is the time we say, but

302
00:15:19.524 --> 00:15:23.244
you can get MRSA from the community.

303
00:15:23.284 --> 00:15:25.564
And that could cause a skin infection or worse?

304
00:15:26.004 --> 00:15:29.204
Or worse. It can go to the lung, the brain, the blood.

305
00:15:29.964 --> 00:15:31.204
It can go anywhere in the body.

306
00:15:31.524 --> 00:15:35.384
So what can someone do to sterilize the surface in the community places like

307
00:15:35.464 --> 00:15:36.504
gym that you use?

308
00:15:36.964 --> 00:15:38.984
Yes. Surfaces where other people touch.

309
00:15:39.164 --> 00:15:39.344
Mm-hmm.

310
00:15:41.384 --> 00:15:42.244
Doorknobs, I think

311
00:15:43.104 --> 00:15:46.624
I would hold the doorknob with a tissue paper or

312
00:15:47.144 --> 00:15:50.444
wash my hands or use a sanitizer after touching

313
00:15:50.484 --> 00:15:54.104
doorknobs or touching surfaces like this, or

314
00:15:54.624 --> 00:15:58.484
the gym. Especially the gym, because the sweaty, moist environment is

315
00:15:58.504 --> 00:16:00.784
conducive also for the bacteria to grow.

316
00:16:00.814 --> 00:16:02.524
So it's primarily in pertaining to the gym-

317
00:16:02.824 --> 00:16:03.214
Gyms are-

318
00:16:03.294 --> 00:16:05.024
... or similar locker room kind of environment?

319
00:16:05.224 --> 00:16:05.564
Yes.

320
00:16:06.724 --> 00:16:06.964
Okay.

321
00:16:07.904 --> 00:16:11.824
Now, there is a topic which gets a lot of talk, but at

322
00:16:11.864 --> 00:16:15.704
the same time does not get enough. That is the antibiotic use in livestock

323
00:16:15.764 --> 00:16:17.284
that we eat.

324
00:16:17.704 --> 00:16:17.984
Mm-hmm.

325
00:16:18.454 --> 00:16:22.224
And antibiotic use in cattle or chicken,

326
00:16:23.344 --> 00:16:25.664
and how does that affect us?

327
00:16:26.704 --> 00:16:28.764
What are some of the downsides that we see from that?

328
00:16:29.324 --> 00:16:32.704
It does affect us. And I'm empathetic

329
00:16:32.724 --> 00:16:36.184
to farmers who are raising

330
00:16:36.724 --> 00:16:39.604
animals or cattle, and if they get sick, what do you do?

331
00:16:39.724 --> 00:16:41.904
Of course, they need antibiotics to treat

332
00:16:43.184 --> 00:16:46.184
the animals. I'm not an expert on animal health, but

333
00:16:47.544 --> 00:16:51.394
the use of the same categories of antibiotics that we use in humans,

334
00:16:52.084 --> 00:16:55.784
using those in livestock has led to significant

335
00:16:55.864 --> 00:16:57.464
resistance in

336
00:16:58.424 --> 00:17:00.904
antibiotics we call quinolones, for example.

337
00:17:01.004 --> 00:17:04.815
And something called C. diff, that's a bacteria that causes

338
00:17:06.984 --> 00:17:10.045
a potentially deadly diarrhea in humans.

339
00:17:10.124 --> 00:17:12.614
If exposed to antibiotics, you can now get C.

340
00:17:12.744 --> 00:17:14.704
diff even if you've never been to a hospital,

341
00:17:16.805 --> 00:17:20.664
because animals get it, and that has to do with antibiotic

342
00:17:20.704 --> 00:17:24.285
prescribing. So it's a complicated

343
00:17:24.325 --> 00:17:27.624
problem, and I can't just simply say, "Oh, nobody should use

344
00:17:27.664 --> 00:17:31.524
antibiotics for animals," but it should really be regulated

345
00:17:33.164 --> 00:17:33.924
and studied more.

346
00:17:35.424 --> 00:17:36.524
And in terms of

347
00:17:37.444 --> 00:17:39.204
if someone does not eat that meat,

348
00:17:40.284 --> 00:17:43.964
does even drinking the milk or coming in

349
00:17:44.044 --> 00:17:46.824
close proximity with those animals, is that enough?

350
00:17:47.964 --> 00:17:51.924
So if you're drinking the milk and the animal just took an antibiotic and it's

351
00:17:51.944 --> 00:17:54.264
still in their system, that's one way.

352
00:17:54.304 --> 00:17:55.504
You'll get the antibiotics

353
00:17:57.004 --> 00:18:00.604
with the milk. But also, the colonization of these

354
00:18:00.644 --> 00:18:03.604
resistant bacteria on the meat when you buy it.

355
00:18:03.904 --> 00:18:07.644
When you buy meat from the supermarket, there's usually bacteria on it,

356
00:18:07.704 --> 00:18:09.444
and that's killed when you cook it.

357
00:18:10.924 --> 00:18:14.804
So they can be colonized with that resistant bacteria and the C.

358
00:18:14.884 --> 00:18:15.524
diff bacteria.

359
00:18:16.140 --> 00:18:17.550
But when you cook it, that should-

360
00:18:18.080 --> 00:18:21.700
Yes, but cross-contamination is so easy to happen in the

361
00:18:21.720 --> 00:18:22.080
kitchen.

362
00:18:22.260 --> 00:18:25.550
So from meat to the vegetables you have in the kitchen-

363
00:18:25.570 --> 00:18:25.620
Yes

364
00:18:25.670 --> 00:18:28.340
... or something, the bacteria can come in close contact and-

365
00:18:28.460 --> 00:18:30.770
Yes. This is the reason they say don't wash your chicken,

366
00:18:31.999 --> 00:18:32.480
is because you

367
00:18:33.320 --> 00:18:37.000
turn the faucet on and water splashes everywhere, and then it takes

368
00:18:37.060 --> 00:18:40.920
the germs to the utensils on the side of the

369
00:18:40.980 --> 00:18:44.120
sink that you're going to use later to cut your salad.

370
00:18:44.160 --> 00:18:46.420
So it's even more subtle than that.

371
00:18:47.060 --> 00:18:48.860
You don't have to use the same cutting board to-

372
00:18:48.880 --> 00:18:49.040
Mm-hmm

373
00:18:49.340 --> 00:18:53.160
... to transfer this bacteria. It could be just the splashes when you're washing

374
00:18:53.200 --> 00:18:56.440
chicken. That's why CDC recommends against washing chicken.

375
00:18:56.740 --> 00:18:57.880
So don't wash chicken?

376
00:18:57.960 --> 00:18:58.660
That's what they say.

377
00:18:59.060 --> 00:18:59.300
Okay.

378
00:18:59.380 --> 00:18:59.580
And I-

379
00:19:00.080 --> 00:19:00.529
Cook it straight up?

380
00:19:00.540 --> 00:19:01.820
I'm not going to say what I do, but yeah.

381
00:19:02.020 --> 00:19:03.260
Okay. What do you do?

382
00:19:03.740 --> 00:19:04.180
I wash it.

383
00:19:05.380 --> 00:19:08.880
I'm very careful about the stream and not splashing the water around.

384
00:19:08.940 --> 00:19:10.700
But it's recommended not to wash it.

385
00:19:11.140 --> 00:19:11.440
Okay.

386
00:19:11.670 --> 00:19:12.420
Yeah. Mm-hmm.

387
00:19:12.460 --> 00:19:14.100
But you wash it, just careful.

388
00:19:14.700 --> 00:19:15.540
I'm very careful.

389
00:19:16.800 --> 00:19:20.420
Got it. So someone got antibiotics, whether they consumed

390
00:19:20.459 --> 00:19:24.080
it or they got it through the milk or whatnot from the

391
00:19:24.120 --> 00:19:26.100
animals. What happens to your gut with that?

392
00:19:27.360 --> 00:19:31.120
So our gut is an entire community of

393
00:19:31.980 --> 00:19:35.900
microbes. So there's billions. I think most people know now, there are billions

394
00:19:35.960 --> 00:19:39.840
of microbes living inside our body, inside our gut, and

395
00:19:39.920 --> 00:19:43.880
on our skin, and those microbes help us with our

396
00:19:43.900 --> 00:19:47.300
life. They manufacture vitamins for us.

397
00:19:48.360 --> 00:19:52.220
It's tremendous what they do to us, and I don't think we scratch the

398
00:19:52.280 --> 00:19:56.120
surface of what they do. We don't even understand exactly what the

399
00:19:56.160 --> 00:19:58.360
microbes do to help our bodies.

400
00:19:59.560 --> 00:20:00.740
And taking

401
00:20:01.760 --> 00:20:04.960
one course or dose of antibiotics can disturb--

402
00:20:06.080 --> 00:20:09.440
The antibiotic doesn't distinguish good bacteria or bad bacteria, so it just

403
00:20:09.500 --> 00:20:12.960
kills bacteria that is susceptible to the

404
00:20:13.000 --> 00:20:16.460
antibiotic, and that can really disturb the balance of

405
00:20:17.520 --> 00:20:19.220
the microbiome, we call it.

406
00:20:20.280 --> 00:20:24.060
And so it can take up to a year for the

407
00:20:24.100 --> 00:20:25.180
microbiome to

408
00:20:26.479 --> 00:20:28.250
be restored completely after taking-

409
00:20:28.269 --> 00:20:28.830
After one course of antibiotic

410
00:20:28.830 --> 00:20:30.240
... one course of antibiotics.

411
00:20:30.320 --> 00:20:30.330
Wow.

412
00:20:30.360 --> 00:20:33.860
Yeah. And babies born by C-section,

413
00:20:34.760 --> 00:20:37.940
their microbiome is different than babies who are born naturally because

414
00:20:38.520 --> 00:20:42.420
babies get also some microbiome from their mom as

415
00:20:42.460 --> 00:20:43.120
they pass

416
00:20:44.520 --> 00:20:45.870
with natural delivery.

417
00:20:46.840 --> 00:20:50.720
And so this is a science that's now starting

418
00:20:50.840 --> 00:20:53.920
to develop, and we're trying to understand, starting to understand

419
00:20:55.920 --> 00:20:59.240
how immense the effect of the microbiome on our body.

420
00:20:59.340 --> 00:21:02.960
It literally talks to our brain through the vagus nerve and sends

421
00:21:03.020 --> 00:21:06.160
signals to our brain, affects mood and depression and

422
00:21:07.060 --> 00:21:08.460
weight, and

423
00:21:09.720 --> 00:21:13.000
I think we cannot live without our microbiome.

424
00:21:13.460 --> 00:21:17.200
Yeah, no, I was reading certain bacteria are related to weight gain.

425
00:21:17.520 --> 00:21:17.620
Yeah.

426
00:21:18.180 --> 00:21:19.600
Obese people have more of that

427
00:21:20.420 --> 00:21:20.880
in a sense.

428
00:21:20.989 --> 00:21:24.720
So what happened is, there was an obese

429
00:21:24.760 --> 00:21:28.160
person who donated fecal microbiota-

430
00:21:28.190 --> 00:21:29.060
Fecal transplant is a thing

431
00:21:29.160 --> 00:21:29.440
... yeah.

432
00:21:30.460 --> 00:21:34.310
So that C. diff infection that I mentioned earlier, the best treatment for it

433
00:21:34.380 --> 00:21:38.320
is to get a healthy stool from a person

434
00:21:38.340 --> 00:21:42.200
who's healthy and give it to that person with the problem, and

435
00:21:42.280 --> 00:21:43.000
that instantly

436
00:21:43.820 --> 00:21:46.860
stops the problem. This is how powerful our microbiome is.

437
00:21:48.260 --> 00:21:52.020
So they did that once, where the donor was an obese

438
00:21:52.080 --> 00:21:54.320
person, and the recipient has never been obese.

439
00:21:54.740 --> 00:21:58.380
And after the procedure was done, the recipient became obese.

440
00:21:59.000 --> 00:22:01.610
Wow. So it's your bacteria which are telling you what to do-

441
00:22:01.980 --> 00:22:02.220
Yes

442
00:22:02.300 --> 00:22:02.920
... for most part.

443
00:22:03.120 --> 00:22:07.060
So you wonder if we're there for them or are they

444
00:22:07.120 --> 00:22:08.570
here for us, really.

445
00:22:09.040 --> 00:22:10.100
Very interesting.

446
00:22:10.160 --> 00:22:10.260
Yeah.

447
00:22:10.489 --> 00:22:13.200
Yeah. This is a medical procedure. Don't do this at home.

448
00:22:13.400 --> 00:22:14.440
Don't do this at home, no.

449
00:22:16.320 --> 00:22:16.540
So

450
00:22:18.200 --> 00:22:21.600
we live life, and if there's an infection, you have to take antibiotics

451
00:22:21.700 --> 00:22:25.480
sometimes. And now that you told me, it takes a year for microbiome to recover, and

452
00:22:25.540 --> 00:22:28.370
sometimes there's more than one course of antibiotics for a bad infection.

453
00:22:29.980 --> 00:22:32.170
Now, what can I do to help my body?

454
00:22:33.040 --> 00:22:36.920
Yes, there's a lot we can do. So this is actually one

455
00:22:36.959 --> 00:22:39.780
of the interests that I have in my career.

456
00:22:42.160 --> 00:22:45.540
I became fascinated with this early on when I started

457
00:22:45.600 --> 00:22:49.500
practicing, where my office was like half

458
00:22:49.560 --> 00:22:50.540
of my patients were

459
00:22:51.700 --> 00:22:54.240
post-menopausal ladies with urinary tract infections.

460
00:22:54.800 --> 00:22:58.580
And it was puzzling to me. Those ladies would have no infections

461
00:22:58.620 --> 00:22:58.909
until

462
00:22:59.740 --> 00:23:03.320
approximately 10 years after menopause, and then they start getting one after the

463
00:23:03.400 --> 00:23:06.720
other, and they can die and can get admitted to the hospital.

464
00:23:07.480 --> 00:23:10.360
So what is it about their bodies that

465
00:23:10.420 --> 00:23:14.340
changed? So I started reading into this, and it wasn't that well-known

466
00:23:14.360 --> 00:23:14.980
at the time,

467
00:23:15.800 --> 00:23:19.640
and discovered that the skin in

468
00:23:19.680 --> 00:23:21.380
the urinary tract,

469
00:23:22.520 --> 00:23:25.380
the health of that skin is dependent on estrogen.

470
00:23:26.120 --> 00:23:29.960
And so once we lose the estrogen, that skin becomes dry

471
00:23:30.000 --> 00:23:33.370
and weakened. The immune cells go away, and

472
00:23:33.400 --> 00:23:35.860
so a bacteria can get in and cause infection.

473
00:23:36.500 --> 00:23:39.480
And so those ladies lived miserable lives.

474
00:23:39.540 --> 00:23:43.360
They would be depressed and feeling shamed, and

475
00:23:44.380 --> 00:23:48.140
all they got from their providers was prescriptions of antibiotics and

476
00:23:48.220 --> 00:23:51.539
lectures on hygiene, and it was really tough.

477
00:23:52.300 --> 00:23:56.070
And so there were some studies showing that if you replace the

478
00:23:56.100 --> 00:23:57.170
hormone topically,

479
00:23:58.320 --> 00:24:02.030
that can stop the problem, and I started prescribing it, and those

480
00:24:02.080 --> 00:24:04.220
ladies were just calling me to say, "Dr.

481
00:24:04.300 --> 00:24:04.510
Karan,

482
00:24:05.580 --> 00:24:09.480
six years, no UTI." Or, "Five years," or, "Three years," and that

483
00:24:09.520 --> 00:24:10.110
really was

484
00:24:11.280 --> 00:24:13.690
tremendous. So this got me thinking.

485
00:24:13.860 --> 00:24:17.828
So infections are caused Or happen when

486
00:24:18.328 --> 00:24:21.168
there's an imbalance between our immune system and the

487
00:24:21.208 --> 00:24:25.068
microbes. And so, what else is

488
00:24:25.108 --> 00:24:26.228
there that

489
00:24:27.348 --> 00:24:30.768
we can modify by non-pharmaceutical interventions,

490
00:24:30.908 --> 00:24:32.918
or just being healthy,

491
00:24:33.788 --> 00:24:37.028
or replacing something where we can prevent or treat infections?

492
00:24:37.548 --> 00:24:39.738
And I have special interest in that topic.

493
00:24:40.488 --> 00:24:43.958
So what more can we do? This is so impressive, just hormone replacement,

494
00:24:44.028 --> 00:24:45.528
recurrent UTI is gone.

495
00:24:46.658 --> 00:24:46.658
Yeah.

496
00:24:46.688 --> 00:24:50.348
For an average person, gets antibiotics, what do you tell that

497
00:24:50.388 --> 00:24:53.948
person, okay, do this, this, and this to help your gut or your body?

498
00:24:53.968 --> 00:24:54.457
For the gut,

499
00:24:55.448 --> 00:24:58.748
you want to rebuild your gut microbiome and keep it healthy.

500
00:24:58.788 --> 00:24:59.918
So it's what you feed,

501
00:25:00.828 --> 00:25:02.648
which germs do you feed

502
00:25:03.788 --> 00:25:04.308
is what

503
00:25:06.528 --> 00:25:07.888
type of microbiome you get.

504
00:25:08.908 --> 00:25:12.768
So there are foods that feed the beneficial

505
00:25:12.808 --> 00:25:15.848
bacteria, such as soluble fibers, for example.

506
00:25:16.368 --> 00:25:19.968
So it all goes back to processing of the food.

507
00:25:20.908 --> 00:25:24.868
There's been studies where the more processed food is,

508
00:25:24.988 --> 00:25:27.328
the less soluble fiber and the less

509
00:25:29.388 --> 00:25:31.568
nutrients there is in it. And as a matter of fact,

510
00:25:32.448 --> 00:25:34.748
the more disease people get when they eat it.

511
00:25:34.788 --> 00:25:38.298
So really it goes back to eating natural

512
00:25:38.428 --> 00:25:41.998
food, and there's another study that showed that

513
00:25:42.388 --> 00:25:46.308
people who cook food from scratch at home, even if

514
00:25:46.328 --> 00:25:50.208
it's the same type of types of meals, are healthier than people who

515
00:25:50.528 --> 00:25:52.608
buy their food cooked or eat out.

516
00:25:53.448 --> 00:25:53.948
And so

517
00:25:55.828 --> 00:25:58.268
keeping ourselves healthy and eating the right food,

518
00:25:59.948 --> 00:26:03.668
that's what prebiotics are, and so it's the food that

519
00:26:03.708 --> 00:26:07.688
feeds the good germs, and then those bacteria are the probiotic, what

520
00:26:07.748 --> 00:26:08.768
we call probiotic.

521
00:26:09.908 --> 00:26:13.648
So eating the right thing and not eating the bad

522
00:26:14.168 --> 00:26:15.848
stuff such as processed food,

523
00:26:16.668 --> 00:26:20.328
pure sugars, especially the high fructose-containing

524
00:26:20.668 --> 00:26:23.328
beverages, those are straightforward.

525
00:26:23.408 --> 00:26:23.988
The highest

526
00:26:25.168 --> 00:26:28.588
bang for the buck if you want to stop something, it's

527
00:26:28.648 --> 00:26:29.828
the high fructose-

528
00:26:29.988 --> 00:26:30.728
The liquid sugar

529
00:26:30.868 --> 00:26:34.568
... liquid sugar, yes. It mucks up the immune system and

530
00:26:34.628 --> 00:26:36.508
causes fatty liver,

531
00:26:37.348 --> 00:26:37.878
and

532
00:26:39.028 --> 00:26:41.637
just really affect our health negatively.

533
00:26:42.308 --> 00:26:43.428
Do fermented foods help?

534
00:26:43.888 --> 00:26:47.808
They're good, yes. And you could see that our ancestors ate them regularly.

535
00:26:47.828 --> 00:26:47.878
Right.

536
00:26:48.328 --> 00:26:51.468
So there has to be an evolutionary

537
00:26:52.788 --> 00:26:56.548
selection to it. So fermented food is good,

538
00:26:57.088 --> 00:26:58.468
and the more

539
00:26:59.668 --> 00:27:03.388
naturally fermented it is, so if you buy the olives in a

540
00:27:03.548 --> 00:27:04.008
can,

541
00:27:06.528 --> 00:27:07.488
I don't think there's much

542
00:27:10.548 --> 00:27:14.488
live microbes in that, but if it's truly pickled

543
00:27:14.608 --> 00:27:16.348
olives, for example, those are healthy.

544
00:27:17.328 --> 00:27:17.538
And

545
00:27:18.848 --> 00:27:21.998
how many servings of fermented food should a normal person have?

546
00:27:22.068 --> 00:27:24.588
I read-- No, I've never looked into this.

547
00:27:24.748 --> 00:27:26.228
I know that it's healthy to eat them-

548
00:27:26.748 --> 00:27:26.888
Right

549
00:27:26.948 --> 00:27:27.278
... probably on a daily-

550
00:27:27.288 --> 00:27:31.228
There was a Stanford small study which recommended three to five servings-

551
00:27:31.568 --> 00:27:31.768
Mm-hmm

552
00:27:31.778 --> 00:27:32.008
... a day-

553
00:27:32.248 --> 00:27:32.258
A day

554
00:27:32.258 --> 00:27:33.238
... in general for health,

555
00:27:34.148 --> 00:27:37.848
and that would include all fermented foods like sauerkraut, kimchi,

556
00:27:38.528 --> 00:27:38.968
kombucha,

557
00:27:39.828 --> 00:27:40.248
whatnot.

558
00:27:40.628 --> 00:27:41.148
I believe it.

559
00:27:41.388 --> 00:27:42.628
What's your favorite?

560
00:27:42.748 --> 00:27:44.888
My husband would be happy. He eats olives with everything.

561
00:27:45.868 --> 00:27:48.888
But there's more to fermented food than olives, obviously.

562
00:27:50.168 --> 00:27:51.488
No, I personally,

563
00:27:53.088 --> 00:27:56.908
I like to eat fermented food with every meal, but it's not everybody's

564
00:27:56.948 --> 00:27:57.438
taste to-

565
00:27:57.528 --> 00:27:59.748
It's a good addition if someone can.

566
00:27:59.828 --> 00:28:01.688
Yes. Like in the sandwich, I put pickle,

567
00:28:02.688 --> 00:28:03.828
olives with breakfast.

568
00:28:04.688 --> 00:28:07.928
Our Middle Eastern food has more pickled food,

569
00:28:08.708 --> 00:28:09.108
naturally.

570
00:28:10.288 --> 00:28:14.208
So it's an essential part of any meal to have

571
00:28:14.228 --> 00:28:15.988
pickled or fermented food.

572
00:28:16.828 --> 00:28:20.748
And do you routinely recommend prebiotics or probiotics for

573
00:28:20.808 --> 00:28:22.688
people who are on antibiotics?

574
00:28:23.388 --> 00:28:27.228
Who are on antibiotics? Yes, I do. Now, the problem with

575
00:28:27.288 --> 00:28:28.368
probiotics is

576
00:28:29.468 --> 00:28:33.108
not all of them show benefit. So there's been many

577
00:28:33.387 --> 00:28:36.708
studies, and there are many products out there on the market,

578
00:28:37.288 --> 00:28:41.068
and not all of them have been shown to prevent the medical

579
00:28:41.108 --> 00:28:44.988
problems that occur, at least very deadly problems such

580
00:28:45.028 --> 00:28:45.587
as C. diff.

581
00:28:46.728 --> 00:28:50.508
So there's one product that I would prescribe

582
00:28:50.648 --> 00:28:54.488
and recommend to take while people

583
00:28:54.528 --> 00:28:58.108
are taking antibiotics. Now, that doesn't mean that other products don't

584
00:28:58.148 --> 00:28:58.568
benefit.

585
00:28:59.628 --> 00:29:03.588
But I, as a physician, prescribe the ones that have

586
00:29:03.668 --> 00:29:04.148
shown

587
00:29:05.228 --> 00:29:08.408
benefit in randomized large clinical trials.

588
00:29:08.418 --> 00:29:09.498
And what is that product for-

589
00:29:09.548 --> 00:29:13.008
It's called Bio-K Plus, so this is not an endorsement of the product, but Bio-K

590
00:29:13.108 --> 00:29:15.948
Plus is the one I prescribe when I prescribe antibiotics.

591
00:29:16.708 --> 00:29:17.048
And

592
00:29:17.868 --> 00:29:21.708
for someone who is not on antibiotics, has not been on it for six months, and I

593
00:29:21.748 --> 00:29:24.108
see a lot of people, they do take probiotics.

594
00:29:25.168 --> 00:29:27.788
Is there any role of that in health?

595
00:29:27.868 --> 00:29:31.328
So for health maintenance, I think there are some studies here and there for

596
00:29:31.368 --> 00:29:34.708
allergies or for inflammatory bowel disease.

597
00:29:35.948 --> 00:29:39.568
I don't tend to study those as much as infectious diseases.

598
00:29:40.948 --> 00:29:44.828
So I would imagine that there are some, but I haven't looked into them.

599
00:29:44.888 --> 00:29:45.388
But there would be,

600
00:29:46.208 --> 00:29:49.748
stands to reason, there would be different probiotics which can suit different

601
00:29:49.808 --> 00:29:52.688
people. So not every probiotic may not be-

602
00:29:54.368 --> 00:29:54.448
Yeah

603
00:29:54.458 --> 00:29:56.898
... a viable one for every person, so to speak.

604
00:29:57.408 --> 00:30:01.318
And not every probiotic that you take by mouth is guaranteed

605
00:30:01.368 --> 00:30:02.548
to get to the stomach-

606
00:30:02.608 --> 00:30:02.808
Right

607
00:30:02.828 --> 00:30:05.988
... because stomach has acid, and that's designed to kill germs.

608
00:30:06.708 --> 00:30:10.508
And yeah. And so does it really get to where it would

609
00:30:10.988 --> 00:30:13.568
work, and then when it works, what is it going to do?

610
00:30:13.688 --> 00:30:17.168
The only way you would find out is if you do

611
00:30:17.728 --> 00:30:20.888
an actual study and look at the outcomes in large numbers, and

612
00:30:21.768 --> 00:30:23.628
look at the statistical significance.

613
00:30:24.472 --> 00:30:25.852
So you mentioned briefly on this,

614
00:30:27.232 --> 00:30:31.212
the gut issues with it can have effect on other

615
00:30:31.252 --> 00:30:34.252
diseases. So when we use antibiotics, it affects the gut

616
00:30:34.552 --> 00:30:38.142
microbiome, it'll affect the lining that the gut is coated with.

617
00:30:38.692 --> 00:30:42.292
And there's some suggestion that it may increase allergies

618
00:30:42.392 --> 00:30:44.652
or autoimmune disease or whatnot.

619
00:30:45.652 --> 00:30:46.872
Is there truth to it?

620
00:30:47.292 --> 00:30:49.992
Yeah, there's been studies that showed an association.

621
00:30:50.672 --> 00:30:53.412
I don't think it was exactly defined as a causation.

622
00:30:54.252 --> 00:30:58.012
But there's an association with children who take more

623
00:30:58.052 --> 00:31:01.602
antibiotics having more diseases such as asthma and

624
00:31:01.652 --> 00:31:02.152
allergy,

625
00:31:03.072 --> 00:31:03.892
and obesity.

626
00:31:05.052 --> 00:31:08.832
So just pivoting a little bit, there's a lot of parents that watch

627
00:31:08.952 --> 00:31:09.232
and

628
00:31:10.692 --> 00:31:12.752
are kids receiving too many antibiotics today?

629
00:31:13.192 --> 00:31:16.952
I think so. And you have people who don't give their kids

630
00:31:16.992 --> 00:31:20.982
antibiotics, but then I see people who, out of love to

631
00:31:21.012 --> 00:31:21.422
their kids,

632
00:31:22.272 --> 00:31:26.112
people do this not with

633
00:31:26.312 --> 00:31:29.962
bad intention, obviously, but because they're worried about their kids, and they

634
00:31:29.992 --> 00:31:31.792
want to help them immediately.

635
00:31:32.592 --> 00:31:35.872
They'll take him to the doctor and then,

636
00:31:37.172 --> 00:31:41.082
that issue of pressure and prescribing practices

637
00:31:42.032 --> 00:31:44.532
can contribute to more prescribing there.

638
00:31:44.612 --> 00:31:48.242
And this early life exposure, obviously, they have much more of life's

639
00:31:48.312 --> 00:31:52.142
runway ahead of them than adults. So this early

640
00:31:52.192 --> 00:31:55.932
life exposure, what problems can this cause for the kids, like a lot of

641
00:31:55.972 --> 00:31:57.552
antibiotic exposure early in life?

642
00:31:57.812 --> 00:32:01.392
Yeah, that's been linked to more asthma, allergies, and

643
00:32:01.452 --> 00:32:03.032
obesity in some studies.

644
00:32:03.252 --> 00:32:04.182
And autoimmune disease.

645
00:32:04.272 --> 00:32:05.192
And autoimmune disease.

646
00:32:06.512 --> 00:32:06.762
And

647
00:32:07.572 --> 00:32:08.172
in terms of

648
00:32:09.552 --> 00:32:13.142
when should parents feel comfortable saying, "You know what?

649
00:32:13.192 --> 00:32:16.982
Can we safely wait?" If someone is wanting to prescribe antibiotics,

650
00:32:17.292 --> 00:32:19.382
when is it reasonable for a parent to just say, "You know what?

651
00:32:20.072 --> 00:32:23.291
Can we wait?" And what should I look for if we need to change this?

652
00:32:24.232 --> 00:32:26.012
If the child doesn't have a fever,

653
00:32:26.912 --> 00:32:28.232
generally it's safe to wait.

654
00:32:29.232 --> 00:32:33.212
And then if it's been a week and they're not getting better, yeah, that's when you

655
00:32:33.291 --> 00:32:33.511
want to

656
00:32:34.672 --> 00:32:35.892
check into it. But,

657
00:32:37.692 --> 00:32:41.512
or going to the doctor and then checking that rapid tests and not

658
00:32:41.572 --> 00:32:43.772
finding the Streptococcus bacteria.

659
00:32:43.812 --> 00:32:47.332
That's the main dangerous one in children is

660
00:32:47.512 --> 00:32:51.092
Streptococcus. It's a type of bacteria that

661
00:32:51.552 --> 00:32:52.532
can cause problems.

662
00:32:53.352 --> 00:32:55.052
If the test is negative,

663
00:32:56.052 --> 00:32:56.512
I would wait.

664
00:32:57.812 --> 00:33:01.532
So for the parents who prefer antibiotics for their kids

665
00:33:01.652 --> 00:33:05.012
anytime they get sick, what advice would you give them? It's not an act of love.

666
00:33:05.372 --> 00:33:08.632
I'm sure it's an act of love and I would never

667
00:33:10.452 --> 00:33:12.512
doubt the intentions, but

668
00:33:13.432 --> 00:33:17.052
just educating that there's really harms, because

669
00:33:17.112 --> 00:33:21.042
I think the general public doesn't see that

670
00:33:21.092 --> 00:33:24.112
there's harm in giving someone antibiotics.

671
00:33:24.512 --> 00:33:28.292
So if there's an infection, if they benefit, they benefit, and if they

672
00:33:28.332 --> 00:33:28.672
don't,

673
00:33:30.572 --> 00:33:33.902
it's not bad. So, educating or

674
00:33:34.332 --> 00:33:35.072
spreading the

675
00:33:36.432 --> 00:33:40.172
data that we have on the effects of antibiotics, I think would make

676
00:33:40.212 --> 00:33:42.772
people make a better choice and more balanced

677
00:33:43.652 --> 00:33:43.952
choice.

678
00:33:44.212 --> 00:33:47.932
So we overstate the benefits of antibiotics in our discourse

679
00:33:48.012 --> 00:33:49.292
and likely understate

680
00:33:50.172 --> 00:33:51.102
the adverse effects-

681
00:33:51.292 --> 00:33:51.652
Correct

682
00:33:51.812 --> 00:33:53.272
... for that, especially for kids.

683
00:33:53.312 --> 00:33:54.152
Mm-hmm.

684
00:33:55.212 --> 00:33:58.572
I'll switch gears a little bit, and we went through a

685
00:33:58.672 --> 00:34:02.372
whole COVID epidemic, and looking

686
00:34:02.452 --> 00:34:04.282
back as an infectious disease doctor,

687
00:34:05.552 --> 00:34:07.872
what is the take home message for you now,

688
00:34:08.792 --> 00:34:11.132
hindsight being 2020, what would you say

689
00:34:12.973 --> 00:34:13.572
lesson learned?

690
00:34:14.112 --> 00:34:17.112
Lesson learned is, well, I think it's not for me maybe, but

691
00:34:18.192 --> 00:34:21.392
mixing politics and medicine is not a good idea.

692
00:34:22.232 --> 00:34:25.212
It was a painful time on all of us

693
00:34:25.312 --> 00:34:29.192
because we were truly having a hard time and

694
00:34:29.872 --> 00:34:32.732
working hard and going through the difficult

695
00:34:33.892 --> 00:34:36.513
treatments and developing protocols and moving fast.

696
00:34:37.152 --> 00:34:40.392
And at the same time, there was a lot of politics going on, and

697
00:34:42.053 --> 00:34:44.852
people trusting the medical community,

698
00:34:46.272 --> 00:34:50.112
that changed. And so the lesson is, I

699
00:34:50.152 --> 00:34:54.072
don't want to be involved in politics, and I'm just a doctor, and I want to

700
00:34:54.172 --> 00:34:54.562
stay away from that.

701
00:34:54.592 --> 00:34:55.522
We want to help people, that's all.

702
00:34:55.612 --> 00:34:58.252
Just want to help people, and that's, yeah, based on what we know.

703
00:34:59.312 --> 00:35:01.292
So if COVID first appeared today,

704
00:35:02.252 --> 00:35:04.952
what would we do differently than what we did?

705
00:35:04.992 --> 00:35:08.832
If it was up to me, again, regardless of how did it start or

706
00:35:08.852 --> 00:35:09.772
where's it, it's here.

707
00:35:10.032 --> 00:35:10.322
Mm-hmm.

708
00:35:10.392 --> 00:35:11.492
So to protect ourselves,

709
00:35:12.452 --> 00:35:16.232
and really those precautions have become very politically

710
00:35:18.152 --> 00:35:18.912
charged. But

711
00:35:20.232 --> 00:35:23.902
I would protect people from getting the infection by

712
00:35:23.952 --> 00:35:25.912
the precautions that we use and-

713
00:35:26.452 --> 00:35:28.052
Hand washing, masks.

714
00:35:28.212 --> 00:35:29.612
Yes, yeah. And I know that-

715
00:35:29.622 --> 00:35:30.992
For vulnerable population especially

716
00:35:31.112 --> 00:35:35.012
... especially, and there's data now, people conflicting whether the

717
00:35:35.112 --> 00:35:39.092
mask helps or not, does not help. It all depends on how the study

718
00:35:39.132 --> 00:35:40.012
is done, and

719
00:35:41.052 --> 00:35:44.192
what does the study look for is what the outcome shows.

720
00:35:44.452 --> 00:35:48.132
So there are studies that show that wearing a mask does not

721
00:35:48.192 --> 00:35:51.052
help, but the study was done in a way that

722
00:35:51.912 --> 00:35:53.712
would not help. So,

723
00:35:54.552 --> 00:35:58.492
yeah, masks do help, and especially if the person

724
00:35:58.532 --> 00:36:02.182
who is sick is wearing them all the time, and that's the only way they would

725
00:36:02.212 --> 00:36:06.092
work. So it's before they get symptoms, and that's why it's

726
00:36:06.112 --> 00:36:09.632
confusing. People are infectious before their symptoms start.

727
00:36:09.692 --> 00:36:13.632
So at that time, during a pandemic, is wearing masks

728
00:36:13.832 --> 00:36:17.652
all the time around people, and that's hard, and it's not easy, and

729
00:36:17.812 --> 00:36:18.032
it's

730
00:36:19.232 --> 00:36:19.952
very difficult.

731
00:36:21.512 --> 00:36:23.052
But implementing that early on,

732
00:36:24.052 --> 00:36:24.572
and maybe

733
00:36:26.180 --> 00:36:27.780
Utilizing that IV

734
00:36:28.900 --> 00:36:30.460
immunoglobulin treatment

735
00:36:31.340 --> 00:36:35.260
early on as well, it helped a little bit until the vaccines came out

736
00:36:35.300 --> 00:36:36.680
and until the medications came out.

737
00:36:37.270 --> 00:36:40.740
There's going to be pandemics in the future. That's not going to stop happening.

738
00:36:41.460 --> 00:36:44.560
And the question is, how well prepared are we for them?

739
00:36:45.340 --> 00:36:46.360
Because they are going to happen-

740
00:36:46.720 --> 00:36:46.910
Why is that?

741
00:36:46.910 --> 00:36:49.820
... whether we like it or not. Because viruses do

742
00:36:50.520 --> 00:36:51.720
mutate and change and

743
00:36:52.560 --> 00:36:56.120
hybridize, and they mutate in animal bodies and our

744
00:36:56.160 --> 00:36:56.600
bodies.

745
00:36:57.900 --> 00:37:00.640
So that's just a fact of nature. We cannot change it.

746
00:37:02.020 --> 00:37:02.220
And

747
00:37:04.280 --> 00:37:06.120
COVID has changed.

748
00:37:07.060 --> 00:37:10.780
A lot of us have immunity, so the pandemic rules, of course, regarding the masks

749
00:37:10.860 --> 00:37:14.660
don't apply now. It'll be difficult to assess

750
00:37:14.720 --> 00:37:16.400
someone who has not had an infection.

751
00:37:16.540 --> 00:37:16.740
But

752
00:37:18.200 --> 00:37:22.100
in terms of infection, is it more like flu now that we

753
00:37:22.160 --> 00:37:23.200
lived with for years?

754
00:37:23.980 --> 00:37:25.860
Yeah, it's less severe now.

755
00:37:25.900 --> 00:37:26.330
It's less severe now.

756
00:37:26.440 --> 00:37:29.560
Yeah, because the majority of us have had some immunity against it,

757
00:37:30.320 --> 00:37:34.200
so it's not as deadly or severe as it used to

758
00:37:34.240 --> 00:37:34.380
be.

759
00:37:34.720 --> 00:37:35.980
Who remains at highest risk?

760
00:37:36.810 --> 00:37:40.270
So groups that are at high risk are at high risk from

761
00:37:40.320 --> 00:37:44.230
influenza and COVID-19 and all viruses, including

762
00:37:44.360 --> 00:37:48.080
RSV, and that's people above 65 years old

763
00:37:48.600 --> 00:37:51.700
or very young, especially premature babies,

764
00:37:52.360 --> 00:37:55.520
people who are taking immunosuppressive medications.

765
00:37:56.200 --> 00:37:59.510
And the most commonly prescribed one is called prednisone or

766
00:38:00.020 --> 00:38:03.120
steroids. Those are given commonly in the

767
00:38:03.160 --> 00:38:04.280
community.

768
00:38:05.160 --> 00:38:06.600
So immunocompromised,

769
00:38:07.860 --> 00:38:08.820
and extremes of age.

770
00:38:11.380 --> 00:38:12.860
Do you see a lot of long COVID?

771
00:38:15.400 --> 00:38:19.100
I used to get those referrals, but because we are infectious disease

772
00:38:19.160 --> 00:38:22.900
physicians, there's no antibiotic or something I can treat it with, so

773
00:38:23.920 --> 00:38:27.860
they ended up being treated at certain centers that focus on them, and they have

774
00:38:27.880 --> 00:38:29.140
research grants for them,

775
00:38:30.060 --> 00:38:31.500
like in Stanford, for example.

776
00:38:34.680 --> 00:38:38.620
But you hear people talk about it once in a while, and I know

777
00:38:38.640 --> 00:38:42.580
people whose lungs changed after having had

778
00:38:42.640 --> 00:38:46.600
the COVID infection. So it definitely

779
00:38:46.620 --> 00:38:47.020
happens.

780
00:38:47.560 --> 00:38:50.960
And so there is a lot, like you hear about either the breathing never went back to

781
00:38:50.980 --> 00:38:52.830
normal or the brain fog that-

782
00:38:53.100 --> 00:38:53.280
Mm-hmm

783
00:38:53.300 --> 00:38:54.240
... is just there.

784
00:38:54.260 --> 00:38:54.449
Mm-hmm.

785
00:38:54.820 --> 00:38:58.640
So for those people, there are specific centers like UC Davis or Stanford

786
00:38:58.650 --> 00:39:01.190
that have the programs to help them?

787
00:39:01.760 --> 00:39:04.660
True. It's like a scar on the immune system.

788
00:39:04.860 --> 00:39:08.640
It causes a change in the way the immune system operates

789
00:39:09.140 --> 00:39:12.060
that is lasting, similar to valley fever, by the way.

790
00:39:13.300 --> 00:39:13.480
And

791
00:39:14.500 --> 00:39:16.500
how have COVID vaccines evolved since?

792
00:39:17.800 --> 00:39:21.040
Do we have new vaccines, like flu vaccines every year?

793
00:39:22.700 --> 00:39:23.180
For COVID?

794
00:39:23.400 --> 00:39:27.080
Not every year. And they stopped being

795
00:39:27.120 --> 00:39:30.780
recommended now as part of the

796
00:39:31.440 --> 00:39:35.200
usual recommendation that we have for patients, and it's a choice

797
00:39:35.320 --> 00:39:39.000
now to give them to the patients who agree to take them.

798
00:39:39.160 --> 00:39:40.260
Or who are at higher risk-

799
00:39:40.340 --> 00:39:40.370
Or want to take them

800
00:39:40.370 --> 00:39:41.100
... they have the option.

801
00:39:41.340 --> 00:39:41.480
Yeah.

802
00:39:41.620 --> 00:39:42.980
But not everyone has to have them.

803
00:39:43.260 --> 00:39:44.700
Yes. It's not recommended.

804
00:39:45.940 --> 00:39:46.620
Flu vaccine.

805
00:39:46.780 --> 00:39:47.000
Mm-hmm.

806
00:39:47.420 --> 00:39:48.400
Do you recommend it for...?

807
00:39:49.260 --> 00:39:50.289
I recommend it, and I take it,

808
00:39:51.660 --> 00:39:53.000
and everybody I know takes it.

809
00:39:54.080 --> 00:39:54.240
So

810
00:39:55.100 --> 00:39:57.900
flu vaccines, do you see that changing?

811
00:39:58.340 --> 00:40:00.780
Like we have mRNA vaccines for COVID.

812
00:40:01.460 --> 00:40:03.650
Do you see that changing for flu vaccine also?

813
00:40:03.700 --> 00:40:05.350
Is that an era that we are headed into?

814
00:40:05.500 --> 00:40:09.120
It's up in the pipeline, yes. It's probably going to happen. Yeah.

815
00:40:10.060 --> 00:40:13.480
And there's a lot of controversy about

816
00:40:13.540 --> 00:40:14.110
vaccines.

817
00:40:15.120 --> 00:40:19.040
If you had to pick subgroups of people who would benefit most from staying

818
00:40:19.080 --> 00:40:21.860
up to date with vaccine, what would that population look like?

819
00:40:22.040 --> 00:40:25.780
Not everyone would be in that, but who would that be if you had to pick certain

820
00:40:25.820 --> 00:40:26.410
subset of people?

821
00:40:26.640 --> 00:40:27.000
Children.

822
00:40:28.040 --> 00:40:31.540
That's the group

823
00:40:31.620 --> 00:40:35.080
where vaccines worked, and it saves the most lives

824
00:40:35.840 --> 00:40:36.300
in children.

825
00:40:37.420 --> 00:40:41.340
And young, healthy adults, is there any vaccines they

826
00:40:41.400 --> 00:40:44.840
should kind of look into on a routine basis, or no?

827
00:40:45.220 --> 00:40:49.180
There are. So vaccines, it's a matter of choice.

828
00:40:49.910 --> 00:40:51.900
Now we have a vaccine, for example.

829
00:40:51.940 --> 00:40:54.410
There are vaccines that protect from cancer,

830
00:40:55.300 --> 00:40:58.640
and this is tremendous. So there's something called HPV,

831
00:40:58.840 --> 00:41:02.360
and HPV is a virus that is sexually

832
00:41:02.400 --> 00:41:04.580
transmitted and

833
00:41:05.720 --> 00:41:09.260
causes cervical cancer, causes throat cancers,

834
00:41:09.520 --> 00:41:12.800
causes other cancers, and there's a vaccine now for

835
00:41:13.200 --> 00:41:16.780
the virus that causes the cancer. So you're preventing

836
00:41:17.100 --> 00:41:20.270
cancer with a vaccine. That's already happening, and we're giving it to our

837
00:41:20.320 --> 00:41:23.940
patients. That's recommended now in preteen

838
00:41:24.000 --> 00:41:24.640
teenagers.

839
00:41:25.480 --> 00:41:26.880
I would definitely recommend it

840
00:41:27.720 --> 00:41:29.620
before they become sexually active.

841
00:41:30.260 --> 00:41:33.900
A hepatitis B vaccination is a vaccine that

842
00:41:33.920 --> 00:41:34.660
prevents cancer,

843
00:41:35.800 --> 00:41:39.680
because hepatitis B can lead to liver cancer.

844
00:41:40.860 --> 00:41:42.960
So all the recommended vaccines really,

845
00:41:43.920 --> 00:41:46.020
they're recommended for a reason, and I would

846
00:41:46.900 --> 00:41:47.260
use them.

847
00:41:48.280 --> 00:41:50.600
Flu vaccine, who should take it in general public?

848
00:41:51.680 --> 00:41:55.410
I take it every year, in part because

849
00:41:55.500 --> 00:41:59.450
it would make the flu less severe on myself, but

850
00:41:59.540 --> 00:42:03.380
also to protect people around and not spread it to the vulnerable around me.

851
00:42:03.700 --> 00:42:05.500
So I think everybody

852
00:42:07.560 --> 00:42:10.380
can, and in my opinion, should take the flu vaccine.

853
00:42:10.620 --> 00:42:14.330
Is the immunity different from what you get from infection versus what you get from

854
00:42:14.360 --> 00:42:14.680
vaccine?

855
00:42:15.080 --> 00:42:18.420
It is different, and immunity from the infection is usually more

856
00:42:18.480 --> 00:42:21.980
lasting or more intense, but again, you're gambling with

857
00:42:22.920 --> 00:42:26.900
the actual infection possibly causing harmful outcomes.

858
00:42:27.980 --> 00:42:28.640
So,

859
00:42:30.100 --> 00:42:31.860
that's the choice that you have to take.

860
00:42:31.960 --> 00:42:35.880
Is there a hybrid immunity that you've had infection and then vaccine?

861
00:42:35.960 --> 00:42:37.020
Is there a benefit to-

862
00:42:37.520 --> 00:42:37.700
Yeah

863
00:42:37.710 --> 00:42:39.230
... that on top of what you had?

864
00:42:39.380 --> 00:42:43.060
So our immune system, the way it works is it makes

865
00:42:43.080 --> 00:42:47.010
antibodies against a virus, for example, and then

866
00:42:47.060 --> 00:42:50.640
there's other viruses. It gets busy with fighting something else and then something

867
00:42:50.680 --> 00:42:51.240
else. And then

868
00:42:53.200 --> 00:42:57.120
making antibodies takes energy, so the body cannot focus on all

869
00:42:57.180 --> 00:43:00.680
infections and make antibodies in the same levels for

870
00:43:00.800 --> 00:43:04.400
all viruses, and so it prioritizes the most

871
00:43:04.460 --> 00:43:07.160
recently exposed one. So

872
00:43:08.100 --> 00:43:11.500
when you give a booster or a vaccine dose again, it

873
00:43:11.580 --> 00:43:15.160
re-boosts the amount of antibodies in the body against that

874
00:43:15.200 --> 00:43:17.260
infection.

875
00:43:17.320 --> 00:43:21.240
Got it. So this is really intriguing conversation, and I think there's a

876
00:43:21.300 --> 00:43:25.240
lot more that we have to talk about, including the valley fever and the hormones

877
00:43:25.260 --> 00:43:27.680
and nutrition as pertains to your infection risk.

878
00:43:28.820 --> 00:43:32.660
So we'll close out here today, and we'll come back for the second part of this

879
00:43:32.700 --> 00:43:33.250
conversation-

880
00:43:33.360 --> 00:43:33.370
All right

881
00:43:33.370 --> 00:43:35.420
... which should be a lot of fun.

882
00:43:35.480 --> 00:43:35.660
All right.

883
00:43:35.680 --> 00:43:36.360
Thank you so much.

884
00:43:36.620 --> 00:43:38.100
Thank you, Dr. Sandhu. It's been fun.

885
00:43:38.560 --> 00:43:38.900
Thank you.

886
00:43:38.920 --> 00:43:39.260
Thanks.