The video starts with a title screen. A maroon and orange gradient aura shifts in the upper right corner of the screen as words appear. They read “Dr. Frank Lipman and Dr. Robert Rountree answer questions about COVID-19 and give some practical advice” and appear over two short resume blurbs about the two doctors. The blurbs read: “Dr. Frank Lipman, M.D., Functional Medicine Doctor, New York Times Best Seller” and “Dr. Robert Rountree, M.D., Functional Medicine Physician, Chief Medical Officer for Thorne.

Dr. Frank Lipman:

I'm in New York city, which is the epicenter. I'm not on the front lines, but from friends and colleagues on the front lines, it's been really hard. Hospitals have been overloaded. People have been really sick. It's been a major problem. 

As Dr. Lipman talks, words appear on the right side of the screen emphasizing his points. The text only serves to clarify what is being said and does not add any new information that isn’t already present in what Dr. Lipman has to say.

Dr. Frank Lipman:

What I'm seeing in my practice or hearing from in my practice, people who either haven't been that sick. A lot of the people who actually haven't been that sick and who have had it, often have had a healthy lifestyle, been taking certain supplements, which is obviously anecdotal, but I'm definitely hearing that.

The second pattern I'm seeing is people seem to be, or some people seem to be having this for a long time. They seem to get over the initial infection and then they get reinfected or something secondary happens that can last for, not just usually a week or two. Sometimes it goes on for three weeks, even longer, some people. The other pattern that we're seeing is that generally the healthy people or what we would call metabolically healthy people are doing better. And the people who're dying or not doing so well are people who have diabetes, heart disease, obese, chronic illness. But generally, what we would call metabolically unhealthy. Those are the patterns we're seeing. And lastly, social distancing definitely works. I mean, New York, we seem to have hit a peak. It seems to be going down. So we need to continue doing that. And as it spreads throughout the country, that's what I would tell you, what I'm seeing in New York.

Another question appears on the screen, reading: “What are some patterns you are noticing in Colorado regarding the virus and its impact on your community?”

Dr. Robert Rountree:

Well, it's definitely here. We haven't been hit nearly to the same level as New York. I think the whole state of Colorado has confirmed around 6,500 cases. And the experts are saying there's probably at least a 10:1 ratio of people that haven't been confirmed. 

A chart on the right side of the screen visualizes the ten-to-one ratio.
 Dr. Robert Rountree:

So that means we maybe have 65,000 cases or so. In my area, Boulder County, there's a few hundred cases. And I should say, only about 10 deaths. When would you ever say only 10 deaths as something to downplay the significance of something? Well, that's just in comparison to New York. So we just haven't been hit as hard. And the whole question is whether we started the social distancing early enough to have already begun to flatten the curve.

The big question that goes on in Boulder, in my community, which is now not quite a ghost town, but the streets are quiet. We have a lot of shopping areas, a downtown mall that's world famous, that's normally packed with people, especially this beautiful spring time of year. And we have lots of athletes. People are here from all over the world to train, bike racing, runners. And so the big debate that's going on right now is, what can you do? How can you safely get outdoors? And if you're jogging, even if you've got a mask or even just a bandana on, is that enough to protect the other people that you could potentially infect if you're asymptomatic. There's not much debate if a person has got symptoms, if they've got a fever and a cough, then they should stay home.

But what about somebody who feels fine, potentially is infected, but doesn't know it? Are you going to tell them to stay home? And so the whole question is this sort of seesaw between your mental health and your physical health. If you stay home for months on end, you never go outside, that's pretty bad for your mental health. So we're really in the midst of a discussion. And we've got a lot of atmospheric researchers in Boulder. So the kind of discussions that we're having about aerosol transmission, the slip stream, what happens when somebody is just breathing out hard? What kind of particles are being released? People are talking about it on the level of physics. They're not just saying, "Hey, I think you should stay home or whatever." They're talking about particle dispersion. And I'm saying, these discussions on the local board, something called Nextdoor, discussions about particle dispersion and the dynamics of air flow and things like that. So that's what's going on in my area.

What are you recommending in your practice for stress, anxiety, and coping on a day-to-day basis?

Dr. Frank Lipman:

There's two pandemics. There's the pandemic of COVID-19. And then there's also the pandemic of the anxiety and the fear because of the virus. And we can't control the virus per se, but we can control our reaction to it. And the way we do that is by learning relaxation techniques. So for people who are hyper and can't sit still, exercise, yoga, any type of movement, dancing around your living room, listening to some Bob Marley, anything like that can be helpful. But anything to activate the parasympathetic nervous system. I'm a huge fan of meditations, changed my life. We tell people to use apps like Headspace, Insight Timer, Journey Meditation. There are all these apps that you can use that are having meditations. The Well actually has classes, meditation classes, yoga classes.

There's so much going on. I think it's an interesting time because this is a really good time to actually start creating these new habits. Because the other thing I'm seeing with patients is that, I'm seeing new Yorkers who are pretty like, go, go, go, go. And their routine, they can't come to terms with slowing down because they're so used to getting up early, going to the gym. So many of these women are these super women who have kids and husbands and jobs. And they're struggling with the slower lifestyle of this. It's a little bit different in Boulder, I'm sure.

And I think the loss of their routine is a big thing. So what I'm encouraging people is to try to create some healthy habits, new routines, because you're going to be living a variation of this for a long time. So try to go to bed at the same time. Try to wake up at the same time. Eat meals at the same time. Get some structure and routine in your life. And start developing new habits like meditation. So it's an interesting time because we can use it positively. I know it's a difficult thing to do. But we can use it positively. All this stuff that we recommending now, it's stuff we've been recommending for the last 20, 30 years.

Dr. Robert Rountree:

You know, the million dollar question here is, why are so many people asymptomatic or minimally symptomatic with the infection? Why aren't we studying that more? Why is it that the number one thing we're studying is, what's different about the immune systems of those people that, maybe they lose their taste for a week or they cough a little bit, they get a fever and then they're fine?

Dr. Frank Lipman:

Exactly.

Dr. Robert Rountree:

What's different?

Dr. Frank Lipman:

Look, this is anecdotal. And I'm not being like Trump and saying this is the cure, because it's a tricky thing. Everything's become so politicized. But what I will say, I have gotten so many emails from patients thanking me for getting them to go on a low carb diet, for eating well, for meditating, for dealing with their stress. I use NAC. I use Quercetin a lot. I use curcumin a lot, for putting them on these supplements, which I actually do believe help. I mean, I can't say for sure. I'm not going to get up there and say, this is the cure. But I've got to say, I'm pretty confident that, as Bob was saying, these patients who've actually changed their lifestyles, are eating well and are taking these supplements, seem to be doing much better. So there's got to be something there. And as Bob says, why aren't we studying those people?

Dr. Robert Rountree:

When I was in my medical training, they talk about, what do you do if you come upon someone who's unconscious? And they talk about the ABCs, airway, breathing, circulation. Well, I talk about the ABCDZ, ABCDZ. Vitamin A, vitamin B, vitamin C, vitamin D and zinc provide this foundation of nutrition, I think help everyone's immune system work better. When people ask me, "Well, if I get sick, should I start taking vitamin C then?" And I'm like, "Why would you wait until you're sick? Why not start the vitamin C now? There's pretty good data that vitamin C keeps your immune system in tip top shape. Same thing with vitamin D, same thing with just basic B vitamins. You don't need massive amounts. But just covering the bases for your B vitamins. All of those things are really critical. And just a little bit of zinc. You don't need hundreds of milligrams of zinc. You need what? 50, 60 milligrams."

Another question appears: “What are some of the natural compounds you’re currently recommending to patients?”

Dr. Robert Rountree:

I would say some of the best research is on quercetin. What is quercetin? Well, besides being one of my all-time favorite supplements, going on 35 years. I've been prescribing it for that long. Is a yellow pigment that's found in most fruits and vegetables, but especially rich in apple skins and onions, especially red onion skin. So onion soup is a really good source of quercetin. But most people, if they're eating salads, they're getting quercitin. So you're already eating it in your diet. But it was discovered years and years ago, that quercetin is the really good immune supportive agent. Some of the early research was on allergies because quercetin stabilizes a type of white blood cell called mast cells. Mast cells release histamine. Histamine is what causes all that nasal congestion and sneezing that you get with allergies, and with the cold.

The one thing about quercetin is that it's very poorly absorbed. So you have to take a lot of it if you're just buying straight quercetin powder. And we're talking 3000 milligrams or so a day. But there was a study on Quercetin Phytosome, which is quercetin that's bound to sunflower lecithin. And that study showed that it dramatically enhanced the absorption of the quercetin. So if you're taking quercetin phytosome, you need generally one or two caps, once or twice a day. It's inexpensive, safe, non-toxic. Kids can take it. Little kids can take it. So it's my top supplement where I just think everyone should take this. And then, if there's any indication that an infection is coming on, you can triple that dose. You could do like 500, three times a day. Frank, you use quercetin, don't you?

Dr. Frank Lipman:

Yeah. I've been using it more often now. But I haven't used it as much as you do. But I do. And now I've been taking it as well. But I use it. But I'm actually starting to use the thorn quercitin phytosome, because as you said, it's better absorbed. I've usually been using it in other formulas. And obviously, it's not enough. But thanks for that.

Dr. Robert Rountree:

There's a pretty good reason to believe that quercetin is a worthwhile thing. Now I'm not saying, hey, just take the quercetin and you're done. I'm just saying that's the top of my list. I think the more the merrier. It's like, this is a [inaudible 00:13:11] of immune supportive agents.

Dr. Frank Lipman:

Vitamin D obviously is one of those nutrients. Also, you can measure it. We see so many people who have low vitamin D. So we can assume that most people need vitamin D. What I'm actually recommending to people who don't have the levels measured, just take 5,000 a day, in the meantime, anyway. 5,000 a day, although some people say it's too much, I've never seen an overdose on 5,000 at all. The most important thing with vitamin A and vitamin D is a fat-soluble. What I hear all the time, people take it, and they're taking it with a salad or they're not taking it with fat. And then it's not going to be absorbed. So the important thing about A and D, you need to take it with fat, otherwise you're not going to get any D into you.

Dr. Robert Rountree:

So the interesting thing about vitamin D is that if the immune system is under functioning, and you add vitamin D, it brings the immune system up to a normal functioning level. But if it's over-functioning, it actually down-regulates it. It decreases the activity of vitamin D, which is why it's been used for autoimmune diseases like multiple sclerosis. So vitamin D, you could call it an adaptogen. It's really a hormone. We think of it as a dietary supplement, but it's working like a hormone that regulates the immune system. Now, this is an important point because I saw a paper that came out of the University of Arizona Integrative Medical Center, where they were saying, be really careful with vitamin D because it could cause a cytokine storm in people that have COVID-19. You know what? I've never seen one study that says that this happens. It's totally fantasy.

There's also a pretty famous nutritionist named Chris Masterton, who says, "If you're taking vitamin D and you get COVID-19, you better stop it immediately, or your immune system's going to go haywire." There's no evidence that that happens. There's just none. And so, it's total speculation. I'm seeing a lot of this kind of speculation out there. Don't take elderberry if you've got COVID because it'll make your immune system go haywire. Well, show me the evidence. If you take your immune cells and put them in a test tube, and add some elderberry, it activates the immune cells. Well, that's what you want. That doesn't mean that herbs like elderberry or [inaudible 00:15:57] or andrographis or any of these immune boosting herbs. That doesn't mean that if you take them over a period of days that your immune system is going to get boosted into the universe. It's not going to skyrocket into the universe. It's not. It doesn't work that way. It's a fundamental misunderstanding of how these herbs work.

More question text appears reading: “What role does the gut play in immune function and supporting people’s health?”

Dr. Frank Lipman:

Well, we can assume it plays an important part because so much of your immune system is around the gut. The problem with the gut is it's a real crap shoot. You don't know what you're doing.

Dr. Robert Rountree:

So to speak.

Dr. Frank Lipman:

I actually recommend prebiotics now more than probiotics, because probiotics are very tricky. I've seen, probiotic, some people do great. And some people, makes no difference. And some people actually can get worse. The probiotics I've, over the years, seen more and more problems. I'm all for probiotics. I love probiotics. But they're trickier with each person's gut. Prebiotics seem to be a much safer and more effective way to treat the gut. And that's where I'm at in this standard. I don't know. It seems to be where I'm heading towards. But I just find it a little bit easier for people to incorporate prebiotics, or less of a problem, put it that way. Probiotics, I see sometimes people have problems with.

Dr. Robert Rountree:

Well, I agree to some extent. I would say I don't really see serious problems with [crosstalk 00:17:43] probiotics. It's more an issue of not knowing exactly which one to use. I think that's the biggest issue.

Dr. Frank Lipman:

Interesting. Just to clarify, I think that's a good point, Bob. But when I say I'm seeing people have problems, it's more, a lot of gas and maybe some diarrhea. Not serious problems. Especially with people with SIBO. So thank you for clarifying. When I'm talking about problems, it's more gas, maybe diarrhea, maybe some other minor, not major problems. They're just harder to pick, put it that way.

Dr. Robert Rountree:

Yeah. So I like to have, say, three or four products that I rotate through. And I'll tell the patient, if you have any kind of intestinal reaction to one, then we can switch it to the other. And so, I rotate through. So I'm using the probiotics, in this case, as a way to boost immunity. And so it must be working through the gut microbiome, even if we're not dramatically changing the gut microbiome the way that prebiotics do, they're still doing something. I think a probiotic is seeding the clouds. The important thing is that it's not necessary to have massive doses to get this effect. The study on probiotics for preventing respiratory infections, they only use like the 5 billion CFU range. And I think maybe some of the people that are having the problems are the ones that are saying, well I need a hundred to 200 billion CFUs, 500 billion CFUs, because more is better. Well, more is not necessarily better. You're seeding the clouds.

Another question appears asking: “how will social distancing help during this pandemic?”

Dr. Frank Lipman:

Yeah. There's no question that it's working. We can see it in New York. And why social distancing works is, I'm obsessed with this viral load concept, the amount of virus you exposed to. If you social distance, you're not really exposing yourself to virus all the time. So I think that's part of it. Why it flattens the curve is, if you're staying away from lots of people, you're not having a lot of people infected all at the same time, which is what the problem has been in New York or Italy and Spain. It overloads the hospital system. So what the benefits of not flattening the curve, not what I'm suggesting, is the only way we're going to get past this on a country level is when we have herd immunity, or maybe a vaccination.

So I think the herd immunity will come about quicker because we've had so many infections. Whereas a place like Australia where they've managed it pretty well, but they're going to have years and years of probably smaller outbreaks. And not so much of a problem, because the herd immunity will take longer to build up. What happens is, let's say I have the virus and I give it to five other people and they develop antibodies to it. And herd immunity means you become immune to it by developing antibodies. And I think a lot of us probably have them already, have been exposed and have them just by being exposed to other people. The more people that have the antibodies, the less of a problem it is.

And I think the future of how we're going to stop social distancing and get back to life is actually probably measuring antibody levels. I think probably everyone should have antibody levels checked, and that can determine what you can do. But we still don't know how effective those antibody levels are, because I just saw something out of Korea that people are getting reactivated. But theoretically, once you test someone and they have antibodies, they shouldn't be getting the infection again, theoretically. But all things are off the charts now. So I'm not sure what the story is with coronavirus. But that's the theory.

Sorry, I'm going off question here. But I think social distancing definitely works because you're staying in your own little circle, you're not spreading the virus. You're not being exposed to the virus. And with a lower amount of people being infected in a smaller amount of time, you're not overloading the hospital system, which is what happened in New York, and is probably going to happen in more and more places across the states. But Bob, I have a question. This viral load thing, this is why I think these young doctors or doctors working on the front lines, especially without PPE, it's crazy, are getting sick because they're exposed. Or their respiratory therapists, in particular, they're exposed to such a big dose of the virus. We don't say that with toxins. But the dose is the poison. What do they say? The dose is a poison. The poison [crosstalk 00:23:24] makes the poison.

Dr. Robert Rountree:

I mean, that's probably true for this particular virus, is that infectious dose. That initial exposure probably explains why so many healthcare providers are getting seriously ill, which has happened all over the world. It happened in China. In China they said, well, it mostly affects old people and healthcare workers. And these healthcare workers were younger. Well, they're getting blasted with these aerosols. So the real question is, how much of a virus can you be exposed to without getting sick? And it's going to take a while to figure that out. But if we knew that, that will answer questions like, well, is it safe to go for a walk if you're wearing a bandana, if you're not wearing a surgical mask or wearing a bandana, which presumably still gives you some exposure? Is that really going to help?

I do want to point out something one of my patients said to me yesterday, which he said, "Look, Bob, let's just clarify. We're talking about physical distancing, not social distancing. He says, I don't want to give up the social stuff because I enjoy having my connections with you. And more and more people are doing exactly what we're doing right now which is talking by Zoom chats or telephone, et cetera." I've even seen some bands do concerts. And that's amazing how they time that so that they're actually playing together. So in terms of our mental health, as we physical distance, we need to figure out how to shorten the social distance but increase the physical distance.

Dr. Frank Lipman:

Yeah. I think that's a really important point. I think a really important aspect of staying healthy is staying connected. Becoming lonely and depressed and being by yourself or not connected is an issue. So I think it's a great point. It's about physical distancing, not social distance.

Text appears asking the next question: “How are your practices adapting to working with patients via telehealth?”

Dr. Robert Rountree:

It's the way it is. I will say that when I first just started to switch over, which wasn't a hard decision. But I said, okay, I've got to see people from home. I thought, well, I'll just call them on the phone. We'll just have a telephone conversation, which I've done on and off for years. But then I've gone back and forth between doing a Skype call or a FaceTime call. And there's really no question that being able to see the person, see what they look like. It's a huge difference. I would much rather have a video conference whenever possible.

More text appears with the next question: “What is your advice for your patients as we continue to navigate the pandemic?”

Dr. Frank Lipman:

Yeah. I think some of it, a lot of it, is out of our control. And you got to be aware of that. But there are lots of things you can control. And your reaction to the situation is the most important. So dealing with the anxiety and the stress and moving your body, taking sleep seriously. What a great time to learn to sleep properly. So all these healthy habits that we've been recommending for years, good sleep, moving your body, dealing with stress, whether it's meditation or yoga or whatever you use, eating well, all becomes a little bit more urgent now. You can't do that.

The problem we're seeing in America in particular, in the black and Latino communities, in the poorer communities are, they unfortunately eat the ultra processed foods because the food industry makes it so cheap and that's what they can afford. I'm hoping this is a time that we can, in the culture, look at all these issues, why this is happening. What foods are people eating? What is the food industry feeding us? Seeing what's important in life. Getting your priorities, right.

I think this is a real good time to reassess not only your own life, but what's going on in the culture, and then how we can change things moving forward. Because I am a hundred percent sure this is not the last virus we're going to have to deal with. These are going to be coming, whether it's next year, in five years time. We don't know. But this is going to be happening. So we need to be able to be strong enough and strengthen ourselves in a way that we're going to have to deal with it. This is just the new reality. We all going to have to deal with it. And hopefully, what Bob and I have been teaching for years permeates the culture a little bit more. Hopefully, the food industry changes. I doubt it, but hope they have. Hopefully people's priorities about what's important in life changes. I mean, these are all more philosophical concepts. But I think this is a good time to start thinking about it.

Dr. Robert Rountree:

We've got to do something different. This situation is forcing us to look at our values. And that's what I want every patient to really think about. Like, okay, the world is going to be different. We don't know what is going to look. There will be another side. We're going to come out of the other side of this. There's no question. Either we'll get enough herd immunity, we'll come up with a vaccine. Something's going to change. This is not going to last forever. The Spanish flu, I think, lasted two years and then died down. Hopefully this won't last that long. It is a finite phenomenon. But what's not finite is what happens to our society on the other side. And so, we all need to be thinking about what that's going to look like, and how we're going to live together as a civilization. We need to re-evaluate the entire planetary civilization. We don't have any choice but to do that.

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