Preventive Medicine Tips

Hello to All! This page which I created years ago has been silent for a while. It is time to change that! I am changing the name of this page to "The Modern Medicine Podcast." As a practicing P*P with 10 plus years experience I plan on recording a monthly podcast with several updates on this page a week. We are going to dissect all aspects of the experience in Modern Medicine. From cutting edge analysis of scientific literature to reports from my experiences on the day to day front lines of medicine: The uplifting Patient stories. The Insurance Company nightmares. The crazy things Drug Company reps say and do to get our interest. And everything in between! This will be a page for anyone interested in all aspects of Modern Medicine that will delve into the day to day experience of what it is like to practice medicine in America in 2024. Like, share, follow and stay tuned!

Wishing you all great health! Best- Dr. Dennis Teehan MD MPH

I have not posted on this page in a while, but I wrote this on my personal page and thought I would post it up here. Food for thought, you could say. Regards- Dr. Dennis Teehan MD MPH

Viruses come and viruses go. The history of life on earth is woven with evolutionary dance of predator and prey. The game of biology is such that when the prey is vulnerable the predator will strike and ultimately thrive. For our current situation with the Covid-19 virus we humans are the prey and the question becomes not only why the virus is such a powerful and effective predator but also why is that happening now?

The Covid-19 is a virulent and powerful enemy. It is likely a pathogen like this would extract its toll at any time in human history. But I don’t think the timing of the current pandemic is entirely an accident either. For years we have heard about the health dangers of the western lifestyle. Obesity, diabetes, hypertension and a sedentary lifestyle all contributing to health risks and some murky concept known as “Chronic Inflammation.”

There is still so much to learn about inflammation and how it contributes to disease processes. When I did my masters in public health, I was lucky to learn from some of the best nutrition scientists in the world about the poorly categorized but powerful relationships between the foods we eat and the way we live and the regulation of our bodies immune system. I had always been a believer in the importance of lifestyle, but even I was shocked to learn that the food we eat and how we live can literally lead to the up or down regulation of potent components of the immune response and profoundly effect our bodies ability to fight disease and heal itself..

We are beginning to learn that Covid-19 preys most strongly on those with chronic illness and the obese. Obesity itself is a powerful influencer of the immune response and we have observed that the outcomes for Obese individuals with Covid-19 are far worse. One NYU study found obesity was the biggest predictor of hospitalization in Covid-19 patients. We also know that other chronic illnesses like Diabetes and Hypertension are powerful predictors and these too are likely contributors to chronic inflammatory states.

A 2017 study in the Archives of medical science found that fat tissues leads directly to the up regulation of of two inflammatory mediators known as interleukin-6 and tumor necrosis factor alpha. This leads to a proinflammatory state and leads to increased stress and damage to cels. IL-6 also induces the liver to produce an inflammatory protein known as CRP, which is known to correlate with increased risk of cardiovascular disease.

We know that inflammatory response is a huge part of the disease process in Covid-19. In fact MGH researchers last week began a clinical trial looking at a medication that blocks IL-6 as a treatment pathway in critically ill Covid patients.

We also know that exercise is a key component of how our bodies regulate inflammation. One recent study from University of Virginia noted that regular exercise leads to increased level of a powerful anti-oxidant known as Superoxide Dismutase. Further research shows that increased levels of this enzyme predict better survival in individuals with Acute Respiratory Distress Syndrome (The study did not specifically look at Covid patients with ARDS).

On a virologic level, we know that the Covid virus enters human cells through a receptor known as the Ace2, which is long known to be upregulated in chronic inflammatory states. To be fair, there are probably also genetic differences in amount of receptor as well.

The link between nutrition, exercise and inflammation is the cutting edge of science. We don’t have all the answers yet. But As much as Covid-19 is a deadly predator under any circumstances we are remiss if we don’t acknowledge that Covid-19 is somewhat a disease of the Western lifestyle and the missing link is how our lifestyle affects our immune response.

In this case A deadly pathogen arose as has happened since the beginning of time and we as a species now with a huge percentage of us with dysregulated immune systems from obesity, a sedentary lifestyle and chronic illness were the ideal prey for it. It seems the very ability of the virus to enter our bodies is dependent on the regulation of our immune response and perhaps this is one of the reason we see such drastic differences in clinical outcomes: from perhaps a majority who have no symptoms to severe disease and death in thousands.

The natural history of this virus being so virulent and human population being so unhealthy created nothing short of the perfect storm for the horror we see today. Viruses come and go, but the timing of this pandemic is no accident. An adept predator acquired the ability to attack vulnerable prey and the result was a devastating pandemic.