Keeping Kids Healthy in the Age of Coronavirus: Dr. Greene on The People’s Pharmacy

Transcript

[00:00:00] Joe Graedon: I’m Joe Graedon.

[00:00:01] Terry Graedon: And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy.

[00:00:06] Joe Graedon: You can find previous podcasts and more information on a range of health topics at PeoplesPharmacy.com. 

[00:00:14] How’s your family holding up during the coronavirus pandemic? Isolation can be especially challenging for children.

[00:00:22] This is the People’s Pharmacy with Terry and Joe Graedon.

[00:00:33] Terry Graedon:  Children appear less susceptible than older adults to serious complications of COVID-19 what do we know about the reasons for that? Closing down the schools is one way to keep youngsters from spreading infection to family members. But having them at home poses challenges for parents.

[00:00:50] Joe Graedon: Are there any treatments that hold promise for COVID-19?   What makes zinc interesting as an antiviral agent?

[00:00:58]Terry Graedon:  In these trying times, having electronic access can be especially reassuring. How can parents manage screen time for their children?

[00:01:06]Joe Graedon:  Coming up on the People’s Pharmacy, keeping kids healthy during the pandemic.

[00:01:14] Welcome to the People’s Pharmacy. I’m Joe Graedon.

[00:01:17]Terry Graedon:  And I’m Terry Graedon. Schools are closed and kids are home, so they don’t catch COVID-19 and spread it to family members.

[00:01:24] Of course, parents don’t want their children to get sick either. How are we keeping kids healthy in the age of Coronavirus?

[00:01:32] Joe Graedon: To find out, we’re talking today with the People’s Pharmacy pediatrician, Dr. Alan Greene. He’s the founder of the pioneer physician website, DrGreene.com.

[00:01:46] Dr. Greene also helped found The Society for Participatory Medicine and was its first president.

[00:01:54] Terry Graedon: Welcome back to the People’s Pharmacy, Dr. Alan Greene.

[00:01:58] Dr. Greene: Terry, great to be back and be with you today.

[00:02:01] Joe Graedon: Dr. Greene. It is terrific to have you with us. And I guess the first question in this time of the coronavirus is, how are you holding up?

[00:02:11] I mean, you’re practicing medicine in the age of COVID-19. That’s gotta be challenging.

[00:02:17] Dr. Greene: Definitely challenging, interesting times indeed, but holding up pretty well. I’ve got a great team of people I’m working with, and it’s a time where we can really make a difference.

[00:02:26] Terry Graedon: How are your patients doing and their parents?

[00:02:30] Dr. Greene: And overall they’re doing pretty well too. This is a very difficult time for kids having been pulled out of school now suddenly recognizing that they really actually did like school all along.  And parents recognizing too, it’s tough having a bunch of kids at home and anxious and needing to learn.

[00:02:50] It’s a unique time. Historic time. This is a time that the kid’s kids, the kid’s, grandkids, will ask them about, and they have this sense of living in history right now.

[00:03:05] Joe Graedon: Dr. Green, I wonder if you have any insights about why children seem to be having less serious reactions to COVID-19.  Now, of course, I’m sure there are exceptions, but in general, we’ve been told the kids get, you know, maybe a little fever and a few little symptoms, but they recover pretty fast.

[00:03:27] So,  any thoughts about that? Yeah, it’s absolutely true that when it comes to getting sick from the SARS COVID 2 virus getting COVID, the illness, kids are much less likely to get sick than adults. And if they do get sick, they’re much less likely for it to be serious.  The symptoms are milder and they tend to have fewer of them.

[00:03:50] The two most common symptoms are cough and fever, the same as the two most common symptoms in adults. But it’s only about half of kids that have a cough and only about half of kids that will have a fever. And then in kids, the next most common is a sore throat, which is a little more common than an adults, but it’s only about 40% of kids have that.

[00:04:09] And then that drops to a much smaller slice that have things like muscle aches or vomiting or diarrhea or pinkeye, that kind of thing, fatigue.  But all at all, they tend to have one or two symptoms and for them to be fairly mild. So why is that? There are several theories. One is that there are Coronaviruses that cause the common cold that are around among kids pretty often, and maybe those are given a little bit of partial immunity.

[00:04:35] I think that’s probably right. Hoping I get a little bit of that as a pediatrician too.  And then the other thing is we know the Coronavirus, the virus gets inside the cells through a specific gateway, a specific receptor, the Ace 2 receptor. And we make more of those every decade throughout our lives. So kids have the fewest, so the fewest open doors for the virus to get into the cells where the damage is caused.

[00:05:03] Terry Graedon: Oh, that’s fascinating.

[00:05:05] Dr. Greene: You mentioned about underlying conditions. Kids with underlying conditions do tend to have it a little bit worse, although it’s just been recently announced by the American Academy of Allergy and Immunology that asthma is not a risk factor for COVID in kids. So that’s good news for all the families out there where they have a child with asthma.

[00:05:27] Joe Graedon: Are there any other conditions that would make a child more vulnerable?

[00:05:33] Dr. Greene: It does look like obesity, type two diabetes, and also type one diabetes, make kids more vulnerable, but remember, even a more vulnerable child is less vulnerable than the typical adult.

[00:05:47] Joe Graedon: Now, you mentioned this, we’ll call it a gateway, the ACE 2 receptor. Is there anything else, you know, a better immune system, for example, whatever we mean by better.

[00:06:01]Dr. Greene:  So kids do have an immune system that’s different than adults.  It is less likely to get out of control to get overactive to cause the cytokine storm that adults sometimes have and it tends to be more responsive at the early end of an infection.

[00:06:19] So it’s better suited to this particular virus, but most respiratory viruses, influenza, tends to impact the elderly and the young kids, the kids under age five, and this one is just behaves differently.

[00:06:33] Terry Graedon: Definitely something new and different that we have not seen before. Now, Dr. Greene, I’m sure that children do get sick.  They come down with this, so occasionally they get quite sick. How were you treating them? Have you had to do that for any of your patients?

[00:06:49] Dr. Greene: So far, the kids in the Bay area that have tested positive for Coronavirus have all been able to be managed as outpatients. And so that’s great. They haven’t been sick enough to need hospitalization, but we are certainly prepared for that.

[00:07:05] And the top line medicine that we would be using is remdesivire and with certain people thinking about hydroxychloroquine and azithromycin as well, although the data’s not all in on that so far.

[00:07:22]Joe Graedon:  Dr. Greene, I heard that remdesivire is really encouraging, that is to say, the preliminary data looks pretty darn good.  Gilead is the company. Can you give us a little insight about remdesivire or maybe how it works and why you have been using it in the Bay area?

[00:07:44] Dr. Greene: That remdesivire that the Gilead product is the one that’s been the most studied out of all the candidate drugs. And so far all of the studies look very promising at improving outcomes.  It’s only available as an IV medication.  So it’s really only for hospitalized patients, but the main reason is that it’s got the most data and the best data so far.

[00:08:08] Joe Graedon: Now, you also mentioned some very controversial drugs and treatments, so hydroxychloroquine, the malaria drug, also used for lupus and rheumatoid arthritis. And I’m particularly interested in zinc because we’re hearing that it’s that combination may be of hydroxychloroquine, maybe azithromycin and zinc that the French have been sort of excited about. And you’ve been, I suspect, checking in with your colleagues all around the world. What are you hearing?

[00:08:42]Dr. Greene:  So that combination of hydroxychloroquine and azithromycin and perhaps zinc has gotten a lot of attention and it’s gotten the attention largely because of the studies coming out of France where they’ve given at first to a very small group of people and then to a group of 80 people, still pretty small who had good outcomes.

[00:09:01] But big caution there though, those were not controlled studies where you were measuring it against something else. So it might be that those people were ones that were going to have good outcomes anyway. 80% of the adults with, with COVID- 19 do have good outcomes and get over it relatively without complication.

[00:09:22] So maybe that was that group. I’m still hopeful that they may be useful medications. And let me explain it a little bit about one pathway that I, that makes me interested in it. And that’s the zinc pathway. Taking a step back, when somebody inhales the coronavirus particles there, they go down into the lining of our lungs.  And we mentioned before that there’s a gateway that they get inside through that ACE 2 receptor and that pulls them into the cells. And they have to get into the cells to be able to cause a problem for us because the virus itself is not alive. It can’t grow, it can’t reproduce. It doesn’t eat, it can’t move on its own. It just passively goes where our air currents pull it or our hands pick it up and touch it to someplace. And it can’t reproduce or cause a worsening problem. But once it gets inside the cell, our own protein machinery recognizes it as something that needs to get copied and starts creating using an enzyme called goes by several names, but replicates is the easiest one that makes more and more and more copies. And within about 12 hours, it’s reproducing exponentially within about three days or millions of the particles that are coming out with each breath and, and certainly with a cough, which can transmit it for quite a while, but it’s been known for a while that zinc can block that replicates zinc inside the cell. And so it’d be great if we could get zinc inside the cell, but zinc doesn’t go into cells either without a gateway being opened up for it. And there are certain compounds that do open a gateway for zinc, and one of them is hydroxychloroquine, and that’s been shown for a while that it can help get zinc into the cell.

[00:11:20]  And you mentioned quercetin, how often given as a supplement, that’s also what’s called the zinc ayana form opens up the zinc pathway so that zinc can get inside the cell. And of course, it’s a flavinol, something you can find in red wine and red grapes, berries. It’s in apples and green tea. It’s in a bunch of places you can find it.

[00:11:40] There are two other classes of ayana forms that I’m pretty excited about as well for getting zinc into the cell. One of them is green tea.  The Epigallocatechin gallate, the EGCG that’s in green tea is effective at getting zinc inside the cell.

[00:12:01] And then the one that does the best job actually of getting zinc inside the cell is coQ10.  And the coQ10 stories are kind of interesting. One way that we get coQ10 and probably historically was the big way we got coQ10 is that when you eat green leafy vegetables that have the chlorophyll in them, so you have spinach, for instance, when we digest that the chlorophyll and its byproducts get into our bloodstream and right under the skin.

[00:12:31] And if you go outside, a couple of hours after you’ve eaten a big salad, then you actually do photosynthesis inside your body, and one of the biggest products of that is coQ10. That may be the biggest way we get coQ10 is being outdoors after green leafy vegetables and that helps drive zinc and into the cells as well.

[00:12:52] Terry Graedon: You are listening to Dr. Alan Greene, founder of the website, DrGreene.com.  In 2010, he founded the WHITEOUT movement to change what babies in the US eat when they first get solid food. Dr. Greene also helped found The Society for Participatory Medicine.

[00:13:14] Joe Graedon: After the break, we’ll learn more about zinc and the viral enzyme replicates.

[00:13:19] Terry Graedon: We’ll also talk about ways to stimulate the immune system.

[00:13:22] Joe Graedon: When your child has a mild to moderate fever, do you need to treat it?

[00:13:35] Terry Graedon: You are listening to the People’s Pharmacy with Joe and Terry Graedon.

[00:13:40] Joe Graedon: The People’s Pharmacy podcast is sponsored in part by Kaya Biotics. KAYA Biotics offers the first probiotics, which are both certified organic and hypoallergenic.

[00:13:54]Terry Graedon:  All probiotics are produced in Germany under laboratory conditions with high-quality ingredients and under strict regulatory oversight.

[00:14:02] Joe Graedon: The three available formulas are created for very specific purposes, such as strengthening the immune system, fighting yeast infections, and helping with weight loss.

[00:14:12] Terry Graedon: To learn more about Kaya Biotics probiotics and the important topic of gut health, you can visit their website, Kayabiotics.com that’s KAYAbiotics.com.   Use the discount code “people” for $10 off your first purchase.

[00:14:40] Joe Graedon: Welcome back to the People’s Pharmacy. I’m Joe Graedon.

[00:14:43]Terry Graedon:  And I’m Terry Graedon.

[00:14:45] Joe Graedon: The People’s Pharmacy is brought to you in part by KAYABiotics. Probiotic products made in Germany from certified organic ingredients, KAYAbiotics.com.

[00:14:57]Terry Graedon:  Also by Verisana, an analytical laboratory providing home health tests for hormones, gut health, and the microbiome online@verisana.com.

[00:15:08] Joe Graedon: Today, we’re talking about keeping kids healthy during the pandemic. How are your children or grandchildren doing?

[00:15:18] Terry Graedon: Our guest is Dr. Alan Greene. He’s a practicing pediatrician and the founder of the pioneer physician website, drgreene.com.

[00:15:34] He’s the author of numerous books, including award-winning, Raising Baby Green and Feeding Baby Green.

[00:15:42] Joe Graedon: Dr. Greene, what you’ve just described is very complex molecular biology and biochemistry, and it’s just fascinating. So let me see if I’ve got this right. In order for the virus to get into us, into ourselves, it has to go through a gateway, and you call that the ACE 2 receptor, right?

[00:16:04] Dr. Greene: That’s right.

[00:16:05] Joe Graedon: And now once it’s inside our cell, it starts to multiply. It starts to replicate. And the enzyme that does that is called replicase.

[00:16:18] Dr. Greene: That’s right. Or RNA dependent. We’ll just skip that one. Replicase.

[00:16:23] Joe Graedon: Okay. Keep it nice and short.

[00:16:25] Dr. Greene: Yeah.

[00:16:25] Joe Graedon: Now something can interfere with that process. That enzyme that’s helping the virus multiply, and that’s something is zinc.

[00:16:37] But in order for zinc to get into that place where replicase is available, it needs a little help and tell us what those things are because I bet most of our listeners have never heard about the things that you’ve just mentioned that facilitate the passage of zinc to where it can do its job.

[00:17:01] Dr. Greene: And I want to be very clear about what we know and don’t know.  We do know that zinc in the cell can stop the virus from replicating.  And we know that there are several substances that get zinc inside the cell that have been shown in previous science before all of this. And those are chloroquine and hydroxychloroquine, quercetin, green tea and CoQ10 and all of those work in that way to drive zinc inside the cell.

[00:17:30] Now, there are not studies yet showing that any combination of those are particularly helpful and that’s just a really good idea based on solid science. But one thing that we do know about zinc is it’s been well studied that taking zinc in a regular common cold, can help reduce the length of the respiratory infection.

[00:17:53] So that’s solid knowledge and blocking other respiratory infections is more important now than ever. And here’s why. In the Bay area, at UCSF where they’ve done a lot of testing and testing for COVID and really only testing the people so far that we have the highest suspicion that they might have it.

[00:18:13] These tend to be people that have the fever and cough and shortness of breath or other respiratory symptoms, and more than 90% of the people tested don’t have COVID.  They have some other respiratory infection. So how great would it be for those people that line up to have a drive-through testing and they’d go through the fear and the anxiety and the isolation and the inconvenience and the increased exposure risk if they didn’t have a respiratory infection in the first place.

[00:18:43] And how great that would be for the medical system not to have to use PPE and time and personnel resources to be able to test people who just have the flu or a cold.

[00:18:53]Joe Graedon:  And if somebody actually does have COVID it’s still important not to have a respiratory infection.  At Stanford, our first experience there, 22% 22.4% of the people who tested positive for COVID also had another respiratory infection at the same time, which tends to make them sicker. So we do know that zinc blocks other viruses. We wonder if it might be really helpful to take it with an ayana form here.

[00:19:21] Terry Graedon: So Dr. Greene, people are thinking zinc, zinc lozenges, for example, zinc gluconate or zinc acetate as lozenges for a cold.   Is there a specific form of zinc that seems to be most helpful against either COVID-19 or these other respiratory infections?

[00:19:44] Dr. Greene: Nope. For COVID-19 we really don’t know.  For other respiratory infections,  the piece that we do know is that the best results have come from getting 75 milligrams a day, and that’s a lot.

[00:19:57] There are some studies showing positive results from as little as 30 milligrams a day. Those lozenges tend to have maybe six milligrams in them, so five or six. So you’re talking at least six lots inches a day. If you’re gonna do the lozenge form, it’s easier in a bunch of other supplements.

[00:20:15] Joe Graedon: Now I guess the question is well, can you overdose on zinc because I’ve, I’ve taken zinc when I’ve had a cold and it, it kind of upsets my stomach. It makes me feel a little nauseated. are there any problems of, you know, just too much.

[00:20:33] Dr. Greene: Zinc overall is pretty well tolerated, although it can make you feel a little bit crummy.

[00:20:39] Many Americans live on the low end of the zinc range anyway, so I’d be a big fan of eating zinc-rich foods, which would be the ______ oysters with the highest level, but shellfish, crab, lobster tend to be pretty high. It’s also in meat and poultry.  But think seeds:  pumpkin seeds, sesame seeds or high cashews are pretty high in zinc.

[00:20:59] So eating zinc-rich foods is a sort of no brainer, a good thing to be consuming. And then the key time for zinc tends to be at the very onset of symptoms. So you don’t have to be taking it all the time as a preventative, but as soon as you are feeling a tickle in the throat, doing it until that goes away is a good idea.

[00:21:17] Terry Graedon: So that very first, that very first hint of a tickle in the throat is the time to take your zinc.

[00:21:24] Dr. Greene: That’s when I do it.

[00:21:25] Joe Graedon: Now, you also mentioned coenzyme Q10 and you told us, well, eat your green leafy vegetables and go out in the sun and let some photosynthesis occur, which I think is mind-boggling in its own right.

[00:21:38] We’ll maybe deal with that some other day.   But, you know, millions, tens of millions of people are taking coenzyme Q10 because they’re on Statins and Statins interfere with the body’s ability to make coenzyme Q10, a natural substance, also known as ubiquinone. And a lot of people drink green tea every day, or actually take green tea supplements.

[00:22:00] So I’m wondering, you know, if somebody wanted to get that zinc into their system without getting access to, for example, hydroxychloroquine, could they be taking coQ10 or green tea?

[00:22:15] Dr. Greene: I think that’s a reasonable choice. We don’t know for sure about that, but, for myself, if I have a tickle in the throat, what I do is I do, a zinc supplement in the morning, that is 30 milligrams.

[00:22:31] And I also have that with some green tea extract. I drink green tea as well, and in the mid-afternoon in the sunshine time when you would be making coQ10, if I’m not going outside, I’ll have another zinc with a coQ10 and in the evening I’ll have zinc with quercetin. And that way I get my, 75 milligrams of zinc and I have three different ways to get it in there.

[00:22:50] But that’s just me. I’m not saying that I’m recommending this to people or that there are studies supporting it. It’s just me reading the science.

[00:22:58] Terry Graedon: Now, most of that, even though its science-based, is not that well known. However, coenzyme Q10 and zinc and quercetin and green tea, you don’t need a prescription for any of that, so people could be self-treating.

[00:23:16] I’m assuming that there’s no problem with that right?

[00:23:19]Dr. Greene:  Those are all very safe. I would follow the instructions that come with them and not do mega doses beyond what is indicated on the label. But, those are things that I would do and my family would do.

[00:23:31] Terry Graedon: Now, we talked a little bit also about a prescription medication that is very controversial, and that would be the hydroxychloroquine.  Why is that so polarizing?

[00:23:43] Dr. Greene: That’s been very polarizing because the data so far supporting hydroxychloroquine is theoretical and from small studies that are not well controlled. And so a lot of doctors, I think appropriately don’t want people to be too excited about it. To be hoarding it for sure, and to be using it unnecessarily because they are medications that have side effects. Among other things, they can prolong the QT interval, the part of the heart rhythm and set people up to have heart arrhythmias if it gets too long, so they are not completely benign. There are prescription medications for a reason and should only be given when the expected benefit is bigger than expected risks.

[00:24:26] Terry Graedon: And right now, we don’t even know if that’s the case for COVID-19 correct?

[00:24:30] Dr. Greene: That’s correct. We don’t, and there’s new data coming all the time, and the next couple of weeks we may know a lot more. I’m glad that they exist. I’m glad people are looking into it. I’m glad there are a number of trials that are ongoing right now, but not enough to say that it is clearly the better choice.

[00:24:46] Terry Graedon: There are also some trials going on for a drug called EIDD some number, which is going to be an oral form in the same category as remdesivir so it will be a pill that people could take, but right now, it’s just starting trials.

[00:25:09] Dr. Greene: Yeah, and that looks also really exciting. Where I’m remdesivir as I mentioned, it’s only available in IV and the EIDD 2801 is something that could be given to people very early in the illness to prevent them from going into the hospital.

[00:25:25] Joe Graedon: Now, Dr. Alan Greene, you have mentioned in essence that children seem to be protected, and one of the possible reasons is that they have less of that receptor called ACE 2. And that as we get older, we get more and more of it, and that makes it easier for the virus to get into our cells. But I think a lot of people are thinking, well, maybe children have a more robust immune system, and when we get to be in our 60’s or 70’s or 80’s, our immune system is just not quite up to snuff. We’re not making as many antibodies. Maybe our white blood cells aren’t as vigorous. So is there anything we can do to “boost our immune systems” that would be, you know, relatively benign and might be helpful.

[00:26:25] Dr. Greene: Well, I’m not sure I agree that it’s because kids have a more robust immune system cause for most respiratory illnesses, they’re the targets rather than the ones who are shielded from it. But having said that, there are other things that tend to decrease respiratory infections in general to make us more resilient to our immune system function better against them. And one of the ones best studied is vitamin D.  With vitamin D there’s some thought that maybe the reason for cold and flu season is that it’s really the vitamin D, the low vitamin D season.  It’s the time where the angle of the sun, we don’t make as much vitamin D when we’re outdoors and we’re outdoors less often, our vitamin D levels drop and maybe that makes our immune system more susceptible.  We know vitamin D is an important part of supporting the innate immune system.

[00:27:16] So some scientists actually tried to put that idea to the test and, and it further fits with the idea in the tropical areas. It’s during the rainy moments where the vitamin D drops some that they’d tend to have the most, respiratory infections.

[00:27:30] So they decided to put it to the test by giving it to school kids either placebo or vitamin D, in the same classrooms. And to follow them through the whole cold and flu season. And for the ones who had not been getting vitamin D and started getting it as a supplement, they had two thirds fewer cases of swab-proven influenza.  It really reduced flu for them.  And there’ve been a number of other studies that have supported that. So I’m a big fan of that.

[00:28:00] Terry Graedon: Now, of course, people are being told to stay inside, so they aren’t necessarily getting sun exposure that would help them make vitamin D. How much vitamin D should someone be taking and is it age-dependent?

[00:28:16] Dr. Greene: It is age-dependent. For someone over about four years old, I suggest 1,000 IU’s of vitamin C.

[00:28:23] Terry Graedon: Vitamin C or Vitamin

[00:28:25] Dr. Greene: D?

[00:28:25] Vitamin D.  Thank you. For someone over about four years old. I suggest 1,000 IU’s of vitamin D. For kids between one and four, I would suggest four to 600 IUs of vitamin D. Once somebody gets sick, I would double that. For adults, that would be higher. It would be at least 2000 IU’s.

[00:28:49] Terry Graedon: Should that be vitamin D2 or vitamin D3?

[00:28:52] Dr. Greene: Vitamin D3 is the most effective.

[00:28:56] Joe Graedon: Is there anything else? You mentioned vitamin C by accident, and there has been some controversy around, well, would vitamin C be beneficial? There are some hospitals that are actually using intravenous vitamin C for people who’ve come down with COVID-19.

[00:29:13] Dr. Greene: Yeah. There are people doing intravenous vitamin C, and a lot of folks recommending it. There’s not again, a lot of data on that, but so in the case of, we talked before about the hydroxychloroquine in kids, the risk-benefit ratio is not great since most kids do so well anyway, why give them medicine that is going to affect their heart?

[00:29:34] Vitamin C’s sort of the opposite. It’s like what harm is it going to do? And maybe it’ll help some. So, I’m not opposed to people taking that. Another thing that I really do like though is, heat and cold. There’ve been a bunch of studies, the Finnish sauna studies showing that spending time in heat and particularly, then the cold plunge afterward can help boost the part of the immune system that COVID tends to suppress. And so I’m a fan of hot baths and then a cold shower at the end.

[00:30:06] Joe Graedon: Wait a minute. Wait just one minute. That sounds a lot like a Finnish sauna.

[00:30:11] Dr. Greene: Exactly.

[00:30:14] Joe Graedon: Is there any evidence to suggest that, the Finns are doing better in general when it comes to viral infections? Does there, I mean, this goes back what hundreds of years, this tradition of heat and cold and heat.

[00:30:29] Dr. Greene: Well, if you look at the Scandinavian countries right now, they look at Finland and Sweden, Norway, Denmark, that whole area. Finland has the lowest rate of COVID going on, and they’re the ones that do these Finnish saunas.  So, it fits with what’s going on there. But that’s not to say that’s the reason.  But there have been studies looking at the saunas, looking at white blood cell counts afterwards, and showing an increase in and monocytes that can be very useful.

[00:30:58] And studies showing decreased respiratory infections after doing that. So again, we’re living in a situation where there’s lots of suggestive ideas and things are well worth studying, which we don’t know yet. I really want to emphasize, we don’t know yet which ones will pan out against COVID, but the ones that there’s very little downside, make sense to try.

[00:31:22] Joe Graedon: Well, you know, it suggests that heat might be beneficial, but most people, when they’ve got a fever reach for the ibuprofen or the acetaminophen or even the aspirin, and that’s been kind of controversial. Could you just give us insight on lowering a mild to moderate fever?  We’ve got about 30 seconds before the break.

[00:31:43] Dr. Greene: So, a fever is part of the body’s immune response to help destroy the virus. And so, it’s a good thing. And if we can get by without suppressing the fever is generally better. Sleep’s important. If the fever is stopping you from sleeping or staying hydrated, then you might want to bring it down. But otherwise, a moderate fever is your friend.

[00:32:03] Terry Graedon: You’re listening to pediatrician Alan Greene. He’s the founder of DrGreene.com,  Whiteout Now and ColorIn. Dr. Greene also helped found The Society for Participatory Medicine and was its first president. He’s the author of several books, including Raising Baby Green and Feeding Baby Green.

[00:32:32] Joe Graedon: After the break, we’ll talk about how families are spending time together.

[00:32:37] Terry Graedon: How should parents adjust their screen time restrictions under these extraordinary conditions.

[00:32:43]Joe Graedon:  Are there ways for kids and their parents to get exercise and still maintain a safe distance from others.

[00:32:50] Terry Graedon: How can you talk with kids about the scary topics that COVID-19 brings up?

[00:32:55] Joe Graedon: We’ll also find out whether there will be lasting lessons for the practice of medicine.

[00:33:18] Terry Graedon: You’re listening to the People’s Pharmacy with Joe and Terry Graydon.

[00:33:24] Joe Graedon: This People’s Pharmacy podcast is brought to you in part by Verisana.com

[00:33:29] Terry Graedon: Verisana Lab offers home health tests that allow you to monitor your hormones and health conditions. You can take control of the quantitative assessment of your health and learn about male and female hormone balance, the stress hormone cortisol, leaky gut, gluten intolerance, or your gut microbiome.

[00:33:49] Joe Graedon: Take a more active role in tracking your health and take 20% off your first order of a male in testing opportunity with the discount code PEOPLE. That’s upper case P E O P L E. To learn more, go to Verisana.com that’s V E R I S A N A.com.

[00:34:22] Terry Graedon: Welcome back to the People’s Pharmacy. I’m Terry Graedon.

[00:34:25]Joe Graedon:  And I’m Joe Graedon. The People’s Pharmacy is brought to you in part by Verisana, an analytical laboratory providing home health tests for hormones, gut health, and the microbiome online@verisana.com

[00:34:43]Terry Graedon:  And buy Kaya Biotics probiotic products made in Germany from certified organic ingredients.  KAYABiotics.com.

[00:34:54] Joe Graedon: Today, our topic is keeping kids healthy during the coronavirus pandemic. The internet has provided an opportunity for people to stay in touch, even though they’re isolated at home. For parents, this may pose something of a dilemma. You don’t want your kids vegging out in front of the computer or TV for hours on end, but you do want them to be able to connect to their friends.

[00:35:19] How can you strike the right balance when it comes to screen time?

[00:35:24] Terry Graedon: How is telemedicine impacting healthcare in the age of COVID-19?   Many medical practices have turned to remote connections for non-emergency care. Will this have a lasting impact on the practice of medicine going forward? Are there other lessons we can learn from this pandemic experience?

[00:35:44] Joe Graedon: We are talking with Dr. Alan Greene, founder of the pediatric website, DrGreene.com.  Dr. Greene is the People’s Pharmacy pediatrician. When we have questions about children’s health, we turn to Dr. Greene. He’s also a founder and one of the first co-chairs of The Society for Participatory Medicine. In addition, Dr. Greene founded Whiteout, a movement to change American babies first solid foods for better health. And Ticc Tocc, Transitioning Immediate Cord Clamping to Optimal Cord Clamping.

[00:36:22] Terry Graedon: Dr. Greene. A lot of families are spending much more time together than they are accustomed to.   Kids who’ve had their lives disrupted; parents have had their lives disrupted.  Do you have any suggestions on how people can cope with being cooped up at home all this time?

[00:36:46]Dr. Greene:  It is tough being cooped up at home. Kids are by nature, love to get out to mingle with their friends and play actively. And the social experience of school itself has a really important thing and it is weighing hard on a lot of families and all being home cooped up together at the same time.

[00:37:08] So a few things we know are helpful and one of them is having some kind of schedule of routine, even in this time that has sort of destroyed our schedules and routines. Help kids know what to expect, what’s coming next, what’s coming after that. Good food does make a big difference.

[00:37:25] When kids don’t get a lot of vegetables and fruit, they tend to be more hyper when they get fast carbs in their diet. The added sugars and refined flours, and people often are turning to comfort foods right now and grabbing the crackers and chips and things like that. But eating real food makes a big difference.

[00:37:48] And this is the ideal time to get kids involved in helping to prepare and cook. It gives them something to do, something to do together, and they’re more likely to eat good food if they are involved in the preparation of it.

[00:38:04] Sleep also makes a huge difference right now and prioritizing sleep helps everybody do better than today and helps the immune system.  So, I’d be a big fan of aiming for the same bedtime every night, doing the same ritual every night before bed and turning off screens a couple of hours before that.

[00:38:21] Joe Graedon: Well, I’m glad you mentioned screens because these days, kids are not getting to hang out with their friends like they used to. In fact, none of us are getting to hang out with our friends like we used to.

[00:38:37] And so we have been relying on our screens to basically keep us connected with the rest of the world with our friends and our family. Kind of give us a “Dr. Alan Greene” perspective on screentime in this time of COVID-19.

[00:38:59]Dr. Greene:  I’m glad you asked that, Joe. I actually get more questions about screen time right now than any other COVID related question from my own families I work with and online as well.   So, in normal times, I think about screen time divided up into four different buckets. All screen time is not equivalent. So, the first bucket is passive screen time, and that’s when you’re sitting and watching a movie or watching a television show, and you’re just relaxing and letting go. And I typically suggest kids try to not get more than an hour of that in a day cause there’s so many other important parts of the day.

[00:39:38] And that the next bucket is interactive screen times where you’re playing a game where you’re engaged, making choices and trying to figure out a puzzle or doing something that requires dexterity and that’s more engaging. And again, during normal times, I suggest about an hour a day for that.

[00:39:58] Then the third bucket is creativity creation.  It’s where you’re using a screen to actually make something. You’re writing a story or writing a poem or making a painting or composing a song or editing a song, and that is something that I encourage kids to do as long as it’s not interfering with the other stuff that needs to happen. School and chores and getting outside and playing and connecting with friends.

[00:40:23] And then the last bucket is communication like we’re doing right now using electronics to connect with somebody else.   And the same thing, I encourage that, as long as it’s not getting in the way, with the things you should be doing. But during this COVID-19 time, many parents are feeling very guilty. That screen time has gone up.

[00:40:43] Screen time use has gone up. I’m fine with it going up. I think that I would sort of double the buckets that I’ve said before so that if kids want to watch a couple of hours a day of something just passive, that seems very reasonable during this unusual time and for kids old enough to tell them, I would explain that this is just for this time while you’re home, but two hours a day and to watch, two hours a day to play a game. And then as much time as you need to connect with family and friends and to create stuff as long as you’re still doing some other things. You need face to face time with the family. You need to prepare food together. You need exercise during this time very much. And it shouldn’t get in the way of that, whether you’re doing it in the home or it’s safe to go for a walk in your neighborhood.  Kids need to do that, but take a breath back and aim most for the kinds of screen time that had the biggest benefit for you.

[00:41:35]Terry Graedon:  I’m so glad you mentioned exercise because once again, we talked about cooped up at home.  Some families have backyards and can get outside, but not everybody does. How can kids get the exercise they need while they’re staying at home sheltering at home?

[00:41:53] Dr. Greene: But while they’re sheltering at home, they can get exercise. There are a number, this is another use of, of screens are going to be powerful, there are a number of online classes where you can do essentially calisthenics without equipment in the home or aerobics or yoga, ways to move. And that’s great for your overall health. It’s great for the immune system in general. And I become more and more convinced in recent years that just movement helps the immune system by getting the lymph circulation moving. Our lymph circulation is how our immune system travels throughout the body much of the time. And that only happens when we contract our muscles or we squeeze or stretch. I think it’s one of the real benefits of something like yoga.

[00:42:39] Terry Graedon: Dr. Greene, these are scary times. How do parents address scary topics with kids? I am sure there are families out there who have relatives in far flung places that are getting sick with COVID-19.  There are maybe some children who have to face the idea that our relative they love has died. How can parents handle that with their children?

[00:43:12] Dr. Greene: And this was a really tough time, and it’s going to depend on the age of the child how much to say.  But one piece of it is actually talking with them and telling them in simple and somewhat reassuring ways what’s going on. If we don’t talk to them about it, they’re their imagination will often run to the worst place.  But if we say that among kids, if they get sick, if you get sick it’s at least a 99.5% chance depending on the age of the child.  We can almost always kids do better, and even for adults, 80% of the time they get better without too big of a problem and some don’t. And if there’s a problem, we’ll deal with that and we’ll go through it together. But actually, vocalizing a little bit of what’s going on balance is useful.

[00:44:06] The other piece that’s really important is to listen and invite them to ask what questions they have. Get them to create something, a drawing or activity with action figures or dolls or whatever where they’re acting out  or using art to express what they’re feeling, what they’re afraid of, what might happen.  And you’ll be much better able to talk if you’ve heard what’s going on, what their questions are.

[00:44:36] Joe Graedon: Dr. Greene, you have been at the forefront of electronic communication first with your website, DrGreene.com. But you’ve also been a strong advocate for participatory medicine. You are one of the founders of the society for participatory medicine, and you are one of the cutting-edge, I’d say, health professionals in this country, and maybe in the world who is using electronic communications as a way to help people become more engaged in their own care.

[00:45:14] At this time of COVID-19, it seems to me that our health system is not working the way it normally does. People are not going in to see their doctor. They’re not taking their children in to see their pediatrician. Even if sometimes they have, you know, an illness that they would normally be very, very vigilant about and make sure they see a health professional.

[00:45:40] But now telemedicine is kind of in the forefront. I wonder if you could give us some insight both in your practice as well as in general of the role of telemedicine, whatever we mean by that, because we’re actually using our screens as well in order to communicate with our health professionals and to get feedback when we’re feeling anxious or perhaps far worse.

[00:46:09] Dr. Greene: So, I’ve been using telemedicine for the families that I work with for quite some time, both the ones that are local, but also when they’re traveling or living for a while and other places. And we’ll connect face-to-face a video conference, as well as many of them, have tools at home that are Bluetooth enabled where I can look in the child’s ear or I can listen to their lungs, or I can check their temperature, listen to their heart from a distance, and it’s very powerful and very useful and I can avoid coming into the office, which is wonderful for families.

[00:46:41] Recently, up until recently, a lot of colleagues of mine have been reluctant to do it.  A lot of families have been reluctant to do it, but at grand rounds at Stanford this last week, which I attended virtually, they said that most now of their outpatient visits are telemedicine visits. Same thing up at UCSFs at their grand rounds.  Most are now telemedicine visits, and both of them said, and we will never go back to the way it was before.

[00:47:10] So this is accelerating a change that had been slowly building and not to make it so you don’t have the possibility of a face to face interaction when needed, but so many things could be handled in a more efficient, quicker connection at the moment when you’ve got a problem than signing up for an appointment down the road sometime.

[00:47:30] Terry Graedon: So, it sounds as though there may be a lasting lesson for the future from this particular moment in history.

[00:47:39] Dr. Greene: I think this is likely to really change the way we think about health and the way that we deliver care to people.

[00:47:48] Joe Graedon: You mentioned some of the technology that you use for example, the ability to look in a child’s ear, to listen to a child’s heart.  How exactly does that work? Obviously the parents are involved with some kind of electronic equipment.

[00:48:05] Dr. Greene: That’s right 

[00:48:06] I’ve been using for a number of years now, a device called TytoCare that fits in the Palm of your hand, feels like an Apple device, not like a medical device, and it lets me look into the ear and listen to the heart and lungs and take the temperature.  It’s fairly expensive. Not, not all families could do that, but now I’m also using an otoscope, but if we’re looking in the ear, that’s like a little pen flashlight. It’s super easy to use. It doesn’t look elegant, but it’s 20 or 30 bucks. And for a family that gets a lot of ear infections, rather than having to go in and have the ears checked all the time, it’s a really easy way to do it.

[00:48:42] Joe Graedon: And I’ve heard that there’s a thermometer that people can use, easy to use, and it records temperature and it’s, the data is actually collected and you can look across the country and get a sense of, well, where do people have fevers and that might reveal, for example, during flu season where the flu is spreading.

[00:49:05] And now during COVID-19 season, it seems like it’s a fast way for people to get a sense of where this epidemic is at any given time.

[00:49:16] Dr. Greene: That’s right. That’s called the Kinsa thermometer. KINSA.  Super simple to use.   Works, with a cell phone or something like that. And you just take the temperature, it records it so you can see your own fever curve over the course of an illness, but you can also see it geographically and in real-time what’s going on in neighborhoods and communities. It’s been around for a while. I first tried it, I don’t remember, probably 2015, something like that, or 2016.   But it’s only now that it’s getting big pickup because people suddenly understand this kind of information is really useful and others have done that with heart rate and heart rate variability and blood pressure so to look at the map of what’s happening around the world.

[00:49:59] Terry Graedon: Dr. Greene,  what other lessons do you think that we’ll be taking forward out of this time of COVID-19 because it is not going to last forever.

[00:50:10] Dr. Greene: It is not going to last forever, but I hope that it gives us a chance to appreciate our health more than ever before and begin to invest in our health, to invest in habits that make a difference for long-term health span.

[00:50:27] And I hope it gives us a chance to appreciate the people that we care about and invest in building relationships with them that stay healthy and strong for a lifetime.

[00:50:40] Terry Graedon: Dr. Alan Greene. Thank you so much for talking with us on the People’s Pharmacy today. We always appreciate it.

[00:50:48] Dr. Greene: Especially now, especially now Terry and Joe.  Love you both so much and great being with you.

[00:50:55] Joe Graedon: You’ve been listening to Dr. Alan Greene, founder of the Pioneer Physician website, DrGreene.com.   In 2010, he founded the Whiteout Movement to change what babies in the US eat when they first get solid food. 

[00:51:18] Dr. Greene also helped found The Society for Participatory Medicine. He’s the author of several books, including Raising Baby Green and Feeding Baby Green.  Lynn Seagull produced today’s show.  Al Woodarski engineered. Dave Graedon edits our interviews. The People’s Pharmacy is produced at the studios of North Carolina public radio WUNC.  This week the show was recorded from our home studio.

[00:51:42] Dr. Greene: The People’s Pharmacy theme music is by BJ Lederman. The People’s Pharmacy is brought to you in part by Verisana, an analytical laboratory providing home health tests for hormones, gut health, and the microbiome online@verisana.com.

[00:51:59]Terry Graedon:  And by Kaya Biotics. Probiotic products made in Germany from certified organic ingredients.   KAYAbiotics.com. 

[00:52:10] Joe Graedon: To buy a CD of today’s show or any other People’s Pharmacy broadcast, you can call (800) 732-2334.  Today’s show is 1,208.   The number 800-372-2334.  On the website at PeoplesPharmacy.com

[00:52:28] Terry Graedon: When you visit the site, you can share your thoughts about today’s show. How has your family been adapting to being at home on lockdown? What challenges have you been facing? Tell us about your experience.

[00:52:41] Joe Graedon: You’ll find articles about the coronavirus and links to original research regarding various experimental treatments for COVID-19 at PeoplesPharmacy.com.  You can learn about hydroxychloroquine, BCG, and when to treat a fever.

[00:52:56] We’d like to learn about your strategies for communicating with family and friends during these uncertain times. Please share your story at PeoplesPharmacy.com.

[00:53:06] Terry Graedon: At PeoplesPharmacy.com you could also sign up for our free online newsletter or subscribe to the free podcast of the show. You’ll never miss another episode. You can even share it with a friend.

[00:53:18]Joe Graedon:  In Durham, North Carolina. I’m Joe Graedon.

[00:53:20]Terry Graedon:  And I’m Terry Graydon. Thank you for listening. Please join us again next week.

[00:53:37] Music Break

[00:53:41] Thank you for listening to the People’s Pharmacy podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show is a free podcast. Takes time and costs money.  If you like what we do and you’d like to help us continue to produce high-quality independent healthcare journalism, please consider chipping in. Even a small donation can make a big difference. All you have to do is go to Peoplespharmacy.com/donate.   Whether its just one time or a monthly donation, you can be part of the team that makes the show possible. Thank you for your continued loyalty and support.