This is a relatively tough time for Americans, but it’s tough times that reveal our true character. We all have a role to play in fighting this virus. For many it means staying home and avoiding other humans. While social distancing helps us collectively, it can be hard on us individually. Our mental health can erode. Depression, anxiety, and paranoia can set in. We can start believing that there is a global conspiracy led by Bill Gates to hurt the economy and cover up the murder of Carol Baskin’s husband. There can be a silver lining, if we do the right things. We can stay healthy, avoid depression, and we may even learn a few things about ourselves in the process.

Below are the top 10 things you can do for your mental, physical, and emotional health in a home isolation situation.

Author’s disclaimer: To be clear, I am taking this pandemic extremely seriously, both professionally as a physician and personally as a parent and son. That being said, there are jokes in this article. Humor is not a reflection on the seriousness of this pandemic but rather as a ploy to get you to keep reading.

10. Get Sun. Because many of us are not supposed to go anywhere, we stay inside. That’s a mistake and leading us to increased levels of depression and pastiness. Most of us have an area to get sun while maintaining our social distancing like a balcony, patio, backyard, roof, window, or mega-yacht. Use this space. Vitamin D from sunlight is crucial for our mood, mental health, and immune system. Lab rats show narcotic-like withdrawal symptoms when sunlight is removed from their habitat. Humans tend to get sad and tired. When I’m getting sun, I try to take off as many layers as I can without getting additional legal charges from my uptight neighbors. Also, morning sun is best for setting our circadian rhythm, exercise, and mindfulness while afternoon sun is best for drinking a lot of wine.

9. Set goals. When I set goals like “Become fluent in Ancient Greek,” “Write the great American Novel,” or stop saying “that’s what she said”, I’m bound to fail. Instead I set the bar low, like learning a card trick, practice mindfulness for 20 minutes, or baking. These goals help to keep us busy, which also helps loneliness, boredom, and the temptation to shop online or spend the whole day treating your body like an amusement park. You know what I mean.

More importantly, these goals will keep our minds’ sharp. The concept of brain plasticity is a two way street. Brain damaged individuals can experience improved function over time by connecting neurons, but this concept can work in reverse. Sharp people can become dull and connections can disappear because of brain plasticity. Six weeks of nothing but the Kardashians and Pornhub can turn a once brilliant mind into a functional idiot.

Once you have your goal, make a specific plan to accomplish it. Ex: I will practice mindfulness for 20 minutes immediately after I brush my teeth or I will practice chainsaw juggling after my 3rd whiskey of the morning. A goal without a specific plan to accomplish it, is just a daydream. I read that on a poster somewhere once. When we fail to plan, we plan to fail, also from a poster. Hang in there, it’s almost Friday. Poster.

8. Sweat. Exercise has found to be as effective as 20mg of Prozac for treatment of depression, and the side effects are way better. I know we can’t go to the gym. Despite this, I’ve been getting great workouts using the “100 pushups” app , Yogaglo.com, and Beachbody.com. Here’s an article on how to get started working out from home: 36,000 Seconds. An Exercise Call to Action by Dr Jason Valadao.

7. Snack. I don’t normally snack because it is terrible for maintaining a healthy weight. That being said, when I’m home like this, I can’t help myself. So this makes our snack choices super important. I’ve been stocking up on pickles, veggies, hummus, nuts, full fat Greek yogurt, nut butters, frozen berries, and popcorn. What do all these things have in common? They’re not processed foods and they won’t lead to crazy amounts of weight gain. Also, their fiber will feed our gut microbiome which promotes better emotional well being and also better poops. To achieve smarter snacking, the key is better decisions at the supermarket because now more than ever, if it’s in the house, we will eat it. Willpower is a finite resource, we shouldn’t use it up by having temptations like potato chips, Cheetos, and Ben and Jerry around the house. Ben and Jerry are a couple of very fit firefighters who live down the street from me…actually they can stay.

6. Prioritize Sleep. I’m working hard on this, here’s what I’m doing. A psychiatrist friend pointed out that with every single mental illness in the DSM 5 (official book of psychiatric diagnoses), we see a sleep disruption. I’m not saying that every psychiatric problem is caused by poor sleep, but sleep is an issue with all. Sometimes it’s a chicken and egg problem. Sometimes it’s a vicious circle, but if we don’t get adequate sleep, our mental health can not improve.

With our mandate to stay home, it’s tempting to stay up to 3AM playing Animal Crossing. Besides eroding our mental health, this can weaken our immune system, and cause weight gain. Sleeping in a little is fine, but we should get to bed at the same time every night. I aim for 9–10PM. Despite being #6 on the list, this is the most important thing.

5. Relax. Give yourself permission to take a sensual bubble bath for one. Enjoy some wine, your favorite music, or a cup of tea. If you watch TV, do this intentionally as well. Make a list of quality movies you’ve never seen, and start watching. Also, avoid excessive amounts of news, reality TV, and anything on the Bravo network as this can lead to depression and loss of IQ points. IMDB’s Top 250 movies and top 150 comedies is a good place to start, but is also a bit ridiculous. How can the top comedy of all time be a silent film and not Spaceballs? Also, if you haven’t seen Game of Thrones, you should. Also, HBO is free right meow.

4. Create. Making a vegetable lasagna or a batch of pecan sandies for a neighbor can brighten their day and yours. Just leave the gifts on their porch or something. Exploring your creative side by writing poetry, painting, or even making a new recipe can be very satisfying. I have been drawing charcoal sketches of my dreams and giving them to my friends. The sketches come in three genres: erotic, horrific nightmares, and both.

3. Make a schedule. I plan the next day while winding down for bed. Having a loose plan keeps me from looking at memes on Instagram through 2nd breakfast and into happy hour. My day plan* has a couple “core” items that will help me move forward in life, a few “FTA (feed the animals)” activities that keep me from getting evicted or fired, and some “Sharpen the Saw” items to keep me from wearing down. I keep the list small and work until it’s done, but when it’s done, I cease being productive. Here’s a copy of today’s plan.

2. Cook. Some of us are gonna be great cooks after this. Some of us will be full blown alcoholics. Some of us may be both. COVID-19 isn’t a pass to start immediately binging on processed food (see #7). The only time we should eat processed foods is in a survival situation.

So for now, we should cook real food and save the Twinkies, Hot Pockets, and Slim Jims for when shit really hits the fan. Also, “Cooking” doesn’t mean you have to make a six course meal for you and your cat. Making soup or even perfecting your morning coffee ritual counts too. Here’s mine.

1. Connect. Check-in with people who may be struggling. Email your best friend. Call your mom. Host a virtual happy hour. DM your supervisor’s daughter. You’ll be glad you did, probably.

What not to do. Normally, I am a big fan of extended fasting, but for most of us, this is the wrong time. We are already deprived of some things, let’s not make things harder on ourselves with extra pressure. I am continuing some light intermittent fasting, which is essentially breakfast skipping, but I still find this to be quite easy, even in relative isolation.

While it might be tempting to start a major DIY home improvement project, these can end with trips to the ER, so it’s best to defer such activities. Also, don’t change your medications until you can chat with your doctor. Basically, pretend like hospitals are a breeding ground for a highly communicable disease that poses a threat to you and your family, because that is pretty much the case.

As a side note, lack of time is the number one reason people give for not exercising, meditating, reading, sleeping enough, corresponding, and cooking. Just saying.

Finally, the book “Solve For Happy” has been the impetus for an incredible positive change in my overall mood and happiness. I can’t recommend it highly enough, especially now. Since I’ve read it, I’ve noticed that my shower crying has decreased in both total time and intensity.

In conclusion, we shouldn’t feel pressure to use this time to start a side business, lose 50 pounds, or prepare for a triathlon, but if we set some small intentions for our time in isolation, when we emerge from lockdown, we can be a healthier and happier version of ourselves with positive habits, new skills, and based on our recent purchasing patterns, super clean buttholes.

If we don’t take care ourselves, we can expect to return from isolation with a beer belly, soul crushing depression, pre-diabetes, scurvy, and an internet porn addiction. The choice is yours. Choose wisely.

*My day plan is taken from a combination of The 7 Habits of Highly Effective People and the motivational speaker Brian Ward.

With COVID-19 fear gripping our society, I felt compelled to share ways to strengthen our immune systems. To be clear, these tips are not a substitute for home-isolation, social-distancing, hand-washing, and other recommended measures. We should all do those things too.  With COVID-19, over 80% of people seem to have mild flu-like symptoms, not requiring medical care, but a small percentage of people need to be hospitalized and some will become critically ill.  Who gets really sick and who doesn’t, has a lot to do with our immune system, which is influenced by age, other medical problems, genetics, but also factors we control.

Author’s disclaimer: I am taking this pandemic extremely seriously, as a physician and personally as a parent and son. That being said, there are jokes in this post. Humor is not a reflection on the seriousness of this pandemic but rather as a ploy to get you to keep reading.

Backstory: I spend most of my time in hospitals, taking care of patients, many with contagious diseases. It’s a regular occurrence for people to cough, sneeze, bleed, vomit, and poop on me, and not just while I’m in line at Walmart, but at work too. Also, I have two small children at home, who attend elementary schools, which have rates of communicable disease higher than Charlie Sheen’s poolhouse.  Despite this, using the advice below, I literally never get sick. Your results may vary.

First disclaimer, I am fully vaccinated and I wash my hands a lot, but I am by no means a germophobe.

Second disclaimer, I wasn’t blessed with an iron clad immune system. As an adolescent, I had pneumonia twice and as a child, suffered from frequent ear infections. In college, I got…Nevermind, it’s not important. The point is, my baseline immune system is average at best.

Why are they shaking hands? C’mon!

Immune system overview and COVID-19:Besides physical barriers like skin and nose hairs, we have two parts to our immune system.  The innate immune system and the adaptive immune system.  The innate system is always working against all potential threats, like an electrified fence.  The adaptive immune system works more like a sleeping security guard.  It only activates when it identifies a new threat or recognizes a past threat.  When activated, the adaptive immune system makes antibodies to help identify and attack invaders.  With COVID-19, those with weakened innate immune systems (electrified fence) tend to do poorly, while those with less strong adaptive immune systems (security guards) do fine.  Transplant patients are an example of the latter whereas the elderly are an example of the former.

Children have strong innate immune systems, but not fully developed adaptive immune systems, which may be why we see less severe illness in them.

Sometimes, we can sort out the right way to do something, by finding the wrong way and doing the opposite, like George Costanza. Two groups of people who suffer from terrible immune systems, are poorly controlled diabetics and meth users. Why is this the case? High blood sugar lowers our innate immune defenses. One study showed for five hours following a high sugar/carb meal, non-diabetics had their immune response reduced by 90%. Diabetics get extra immunizations because their immune system is weakened and their high blood sugar is a breeding ground for infection.  Bacteria grow fastest in the lab on agar, which is a sugary gelatin, but not as delicious as it sounds.

What about meth users? They go many days without sleeping. This wrecks their immune system and they are prone to all sorts of infections, and not just the sexually transmitted ones.  Studies show that rats who aren’t allowed to sleep, die of infection after only 7 days, because their innate immune systems shut down entirely.  Human studies show that four nights of poor sleep weakens elements of our innate immune system by over 50%.  Here’s my article discussing the importance of sleep.

So don’t blow your COVID-19 stimulus check on sweet tea, Monster Energy Drinks, and crystal meth? I know that’s not breaking news, but getting the proper amount of restorative sleep is clinically proven to be crucial.  Furthermore, since restricting carbs, especially carbs in the form of sugar, wheat, and processed food, my immune system has become strong to quite strong. I have seen similar results in my patients as well.  Here are some other things that may help…

Having normal levels of vitamin D helps our immune system, but it must be the D we get from sunlight and diet.  If you are found to be low and then take supplements, there’s probably no benefit.  So get outside and eat a diet rich in vitamin D.  Side note, I’ve never seen a super sick person with a great tan, so there must be something to this sunlight thing.

Manage chronic stress.  When doctors want to turn off someone’s immune system, we give them cortisol (corticosteroids), our stress hormone. This is helpful if they have an over active immune condition that is hurting their body but it’s bad for fighting viruses, especially COVID-19, except in certain ICU circumstances.  Keeping our cortisol levels low is super important for healthy immune function.  Here’s how to fight chronic stress. 

Exercise, but skip the ultramarathon. Reasonable amounts of exercise are immune enhancing but if you find that you’re regularly crapping yourself during training or if your nipples are currently bleeding, that’s not good.  Studies show that prolonged, extreme, intense, endurance workouts can temporarily weaken our immune systems.

Our bodies can only operate in one mode at a time. We can’t run from a tiger and maintain an erection or train for an ironman triathlon and fight off a virus.  Alternatively, yoga, weight lifting, Tabata (brief high intensity interval training), light jogging, and brisk walks are great for both physical, mental, and immune health.

Take vitamin C but stop drinking OJ and other things that are high in sugar.  Orange juice (even fresh squeezed with no sugar added) is loaded in sugar. Whole oranges are healthful, but when we juice them (and other fruits) we take out the fiber and are left with a sugar (fructose) bomb.  2000mg of vitamin C per day has been shown to help our bodies recover from illness, but even this is controversial.* Higher levels can cause diarrhea and haven’t been shown to be helpful.  Also, I recommend taking 40mg of oral zinc daily.

What about other anti-oxidants? Don’t they help our immune system? Yes and no. Imagine a virus as an axe-murderer in your home. Your immune system is you with a machine gun, but you are a terrible shot. So in the process of defending yourself, you shoot up your house and hopefully kill the axe-murderer. The machine gun represents our white blood cells and the bullets are “reactive oxidative species (ROS)” or “free radicals” which are deadly to intruders but also cause a lot of damage to our home (AKA our body).  In fact, these bullets keep bouncing off of our walls until neutralized by anti-oxidants.  Every bounce could be a hit to your DNA, leading to damage, aging, or even cancer.

Without anti-oxidants, our immune system would do a lot more damage to our body every time it’s activated. Anti-oxidants also protect our cells against free radicals from UV rays, pollution, cigarette smoke, and chemical pesticides. The point is that anti-oxidants are great, but technically they don’t actually fight infections.  They limit collateral damage.

Tumeric is a tasty spice that has a little evidence that it helps inflammation and immune function. I like it in food, but also coffee and tea. If you are on blood thinners, you need to ask your doctor before starting supplementation. This also applies to garlic, except I don’t put it in my coffee and tea, and you don’t have to ask your doctor.

Chicken soup. This is not just something your grandmother says. Real scientific studies have shown its immune boosting properties. I like mine hot and spicy because it helps to drain and open my sinuses.  Vegetable soup would probably work too.

Hot and Cold. Sauna has shown incredible benefits for immune function, but since the COVID-19 shutdown, my sauna has been closed. I’m experimenting with hot baths but I don’t get the same euphoria, maybe it’s the lack of hot sweaty dudes. Periodic cold exposure, contrary to popular belief, can also boost immune function. I hate cold showers, so I’m regularly jumping in a cold pool which is also great for getting deep sleep.  Here’s a protocol to check out. 

ACV with Honey. Apple cider vinegar lowers blood sugar and has anti-oxidant properties and honey is great for sore throats and cough.  I combine them with hot water and add fresh ginger, turmeric, and garlic at the first sign of a throat tickle or sniffle.

Fun Fact: When drug companies were testing kid’s cough syrup, honey served as the “control” drug and honey outperformed any cough medicine big pharma could safely offer kids. Don’t give honey to children under one or anyone with a severe honey allergy. Incidentally, I get a rash from honey when it’s applied at high temperatures to my feet and ankles.

Today, more than ever, we must keep our body’s immune defense strong and ready for a fight.  Vince Lomabardi said, “The best defense is a good offense”, but with COVID-19, I say that an even better defense is just staying the f**k home.  Please consider these immune system tips long after our COVID-19 crisis is over.  Thanks for reading, please stay safe, and God Bless.

*Vitamin A and E, also help immune function but both are fat soluble and the body can recycle these vitamins, so supplementation of A and E is generally not needed.  Vitamin C can only be used once and is water soluble, so it’s tough to overdose and our supply needs to be replenished daily in the form of a healthy diet and/or supplements.

Within minutes of this paper’s release, my buddy, (and blog contributor) Dr. Jason Valadao texted me the link.  I later replied with a thumbs up, two big hearts, gold trophy, and five eggplants emojis.  This article is a big deal because The New England Journal of Medicine (NEJM) is the most highly respected medical publication in the world, just narrowly beating out JAMA, The Lancet, and DrJimmywestbrook.com.  The NEJM’s recent extensive article on the many benefits of intermittent fasting (IF) marks a turning point in the study of health.  It firmly puts tired statements like, “eat 6 small meals per day,” and “breakfast is the most important meal of the day,” in the same category as those old timey scientific proclamations, “smoking helps us breathe better,” “masturbation will make you go blind,” and “redheads don’t have souls.”  This post is a very brief summary of the NEJM article, but not a how-to guide of IF.  Here’s a link to the full NEJM article and here’s a link to my short guide to easy intermittent fasting.

Defining IF.  The NEJM defines IF as, eating in a 6-8 hour window each day, with 16-18 hours of fasting (18:6 vs 16:8) or eating normally for five days per week and only eating one moderate sized meal per day on the other two non-consecutive days (5:2).

Daily Caloric Restriction (CR).  Animal studies have repeatedly shown that calorie restriction extends the lifespan of animals, ranging from yeasts and worms to dogs, rats, and monkeys.  The life extension can be dramatic, up to 80% in some cases and the restriction does not have to be lifelong.  Even starting CR in older animals shows a huge life extending benefit.

This is the face of daily caloric restriction.

The problem is that daily CR can be miserable.  These animals may live longer but they often seem to be praying for death, and there are side effects like brain shrinkage (seen in monkeys), depression, cold intolerance, decreased energy, and slow metabolism.  Humans subjected to daily CR also start resembling Woody Allen, an unpleasant side effect indeed.

It seems that the benefits of CR may be a result of the restricted feeding time window and not the CR.  In more recent experiments, animals were not calorie restricted, but their feeding was time restricted (IF) which showed the same life-extending benefits of CR, but is much easier for humans to follow and doesn’t have the unwanted side effects.

What Happens when we intermittently fast?  IF obviously helps us lose weight, but so does Jenny Craig. So what’s the big deal? I’ll tell you.  When we fast, our bodies switch fuels, from glucose to fats (in the form of ketones).  This switching to ketones acts as a signal to the body to activate a host of anti-aging processes.  IF allows for old, useless cells to be killed (autophagy), which doesn’t occur when we stay in a “fed” state, here’s a link to my article about it.  Even better, after the old cells die, new young cells take their place.  Studies show that the benefits of IF are independent of the healthy effects of weight loss and therefore IF is a good idea whether we are overweight or normal weight.  Here are some more benefits of IF discussed in the NEJM article:

–Weight Loss:  This seems obvious, but the type of weight we lose is also super important.  Studies show that IF causes greater loss of body fat, specifically abdominal fat, resulting in a smaller waist circumference, as compared with caloric restriction.

–Maintenance of muscle mass.  Keeping your muscle mass when you’re losing weight is important for metabolism, insulin sensitivity, and increasing your odds of waking up with attractive strangers.  Studies show that IF is great for this as well.

–Heart Health.  Decreased inflammation, blood pressure, and LDL (bad) cholesterol are all helpful for keeping your ticker healthy, and are coincidentally all documented benefits of IF.  The subtle theme of this post is that IF is good for you.

–Brain Health.  IF research has shown improvements in cognition, balance, coordination, and active memory, both in young people and in older folks with dementia.  IF has shown promise (in animal models) to reduce the risk of stroke, Alzheimer’s, Parkinson’s, and other neurodegenerative diseases.

–Type II Diabetes.  IF cures type II diabetes.  That’s all I have to say about that.

–Cancer.  As we age our risk of cancer increases exponentially.  IF is shown to prevent cancer through many different mechanisms, but IF also shows promise in improving the survival of those with active cancer, and reducing the side effects of chemotherapy.   Despite this new research, patients with cancer are often told to try to gain weight, and thus are discouraged from fasting, but I expect this will change soon.

–Other.  IF has shown early evidence of benefit in rheumatoid arthritis, multiple sclerosis, asthma, traumatic brain injury, spinal cord injury, other inflammatory or autoimmune conditions, and the gum disease gingivitis.  That last one may be bullshit.

Bear Avoidance is the most important

Dr. Jimmy’s Editorial Conclusion:  So, why does IF help all these very different health issues?  Here’s my take.  Our single greatest risk factor for all of these diseases is age and IF fights the aging process.  Our bodies don’t have a clock that keeps track of time in hours, days, and hockey seasons.  Instead, our bodies age by detecting things like inflammation, nutrient consumption, cell divisions, and damage to our DNA.

IF reduces our body’s inflammation, strengthens our DNA, lowers insulin, and keeps things tight both at the cellular level and with regards to our midsections.  Many people say that they don’t want to live to be 95 or 100.  What if you feel amazing at 94, with a sharp mind, supple body, an active sex life (gross), and you just inked a sweet deal with a member of the Nigerian Royal family who needs five hundred dollars in order to access his family’s vast fortune which he will share with you?  Cha-ching!  Would you still want to check out at 95?  I didn’t think so.

IF has shown that it can fix what ails us today and delay what is coming down the road tomorrow.  Also IF is pretty easy, as well as being free.  So instead of making the same doomed and clichéd New Year’s resolution to lose 30 pounds by joining a gym, counting calories, or cutting off a limb, start IF to lose the 30 pounds and in the process you may gain 30 years.  Thank you for coming to my Ted Talk.