C19 Weekly Briefing Supplement on the importance of maintaining high circulating levels of neutralizing antibodies through vaccine boosters.  

Booster Shots

The new wave of the pandemic is being driven by Delta which bypasses prior immunity at a higher rate than any previous variant.  How is Delta managing to do this?  It appears likely that some combination of mutations allow it to escape key neutralizing antibodies while affording it the ability to generate more viral copies (viral titers among people infected with Delta are 1,000 times higher than those of people infected with the original strain of the virus), combined with timing.  People have the highest level of neutralizing antibodies shortly after getting vaccinated or infected and then those levels wane gradually over months until they are low enough to allow for breakthrough infections.  It is likely that those who were vaccinated or infected several months ago have less immune protection against getting infected than those who were vaccinated or got infected more recently.  

The process of getting C19 starts with exposure–a person inhales viral aerosols that stick to mucous membranes in the nose, nasopharynx, or lungs.  This is called colonization.  If someone has high levels of circulating neutralizing antibodies in the immune system of the mucous membranes (called the "MALT"), they can kill off the virus before it penetrates into the body's interior to cause an infection.  This is what happens in most people who were recently vaccinated.  However, as circulating neutralizing antibody titers wane over time, the MALT has fewer soldiers to keep colonization contained and this allows breakthrough infections to occur.

There are now sufficiently ample data showing that an additional shot of vaccine boosts circulating neutralizing antibodies to levels much higher than those seen after completion of the initial vaccination regimen.  This should provide those who get booster shots with much stronger protection against getting infected (lots of neutralizing antibodies circulating in the MALT).  And there have been no reports of adverse events from receiving a third shot of mRNA vaccine or a second shot of Janssen vaccine.  So what's the delay and why are so many experts still not recommending booster shots across the board?  Three reasons have been given: 

1. It isn't fair that some people get a third shot when others have not received even one shot.  This is the argument the WHO is making against boosters in rich countries.  And on a global level, they have a good point.  But this is not a scientific argument and domestically, we have more vaccine here than people who want it.  In fact, we are throwing out thousands of doses every day.  Why not make use of them instead of throwing them away? 
2. Breakthrough infections rarely lead to severe disease because B and T cells are durable and once the infection takes hold in someone who has been vaccinated, it is very unlikely to land them in the hospital and extremely unlikely to kill them.  Therefore, since breakthrough infections are less severe, boosters are not needed.  True, but C19 is a disease with at least two and possibly three phases.  The first is the acute viral phase when some people get very sick and die.  The current standard vaccination regimen, as stated, is sufficient to protect against this.  The second is the post-viral phase when about 30% of people struggle with ongoing physical and mental symptoms (long-covid).  And a potential third phase to the disease has yet to be seen: what happens down the road to patients whose hearts, brains, blood vessels, lungs, etc., have been damaged by the primary infection?  Will they develop higher rates of cardiovascular or Altzheimer's disease?   These latter two phases of C19 can happen to people who have mild or even asymptomatic viral periods and there is no indication that this will not happen or will happen less often among vaccinated persons who experience breakthrough infections.  
3. We don't yet know if boosters will help, harm, or do nothing because large scale Phase III clinical trials have not been conducted.  That's also true, but there are significant preliminary data showing boosters to be both safe and likely highly effective at helping prevent infections and no data to suggest otherwise.    

The focus of most public health and infectious disease experts has been on the acute viral period of C19.  That's largely because, while some other infections can cause long-term health consequences, most do not, and most doctors by training are concerned about preventing severe illness and death.  But C19 has shown itself to be different from other common RTIs in so many ways (it's airborne, it's more contagious, it's more deadly, it shape-shifts more quickly than expected, etc.) and the fact that it causes such a high degree of chronic and potentially chronic illness is just one more distinguishing feature of this novel virus.  It is not unreasonable to be concerned that in the end, the second and third phases of C19 will wind up taking a larger toll on society than the (sometimes deadly) first phase.  If boosters were available today, I'd take one immediately.  

943. Iceland recommends booster shots for all citizens who got Janssen at 8 weeks post-vaccination.  
https://www.landlaeknir.is/um-embaettid/frettir/frett/item47133/maelt-med-orvunarbolusetningu-fyrir-einstaklinga-sem-fengu-covid-19-boluefni-janssen

944.  Moderna seeks authorization of the first variant-specific booster shot; but it's tuned to Beta, not Delta.  
https://www.healio.com/news/primary-care/20210225/moderna-sends-variantspecific-vaccine-to-nih-for-clinical-study

945.  Pfizer submits data from Phase I clinical trials on booster doses which they now recommend for the general population.  Boosters triggered the production of significantly higher levels of circulating neutralizing antibodies against Delta.  
https://www.cnbc.com/2021/08/16/covid-vaccine-booster-shot-pfizer-submits-data-to-fda-for-approval.html

946.  Dr. Fauci: "Everyone will need a booster shot."  
https://www.cnbc.com/2021/08/12/covid-booster-shot-fauci-says-it-is-likely-everybody-will-eventually-need-a-third-vaccine.html

947.  Israel is now doing booster shots for all persons 50 and over and for all healthcare workers. 
https://www.voanews.com/middle-east/israel-rolls-out-covid-booster-shots-anyone-over-50

948.  Biden Administration to approve booster shots for most Americans at 8 months post-vax, beginning with healthcare workers. 
https://www.nytimes.com/2021/08/16/us/politics/booster-shots.html

Is soy healthy?  

​In my practice I have encountered a widely-held belief that eating tofu/soy can be unhealthy.  Soy contains phytoestrogens.  Phytoestrogens are chemically similar to the mammalian hormone estrogen.  The idea is that consuming soy could cause the body to react to phytoestrogens the way it would to estrogen.  In men, claims have been made that soy consumption leads to low sperm count and generalized feminization including breast development.  In fact studies have not borne this out, and even consumption of very high amounts of soy or soy-based products have been shown to have no such effects on humans.  Another common myth about soy is that it could promote or accelerate the growth of certain types of cancer cells that are estrogen sensitive (such as breast cancer).  In fact, studies have shown that soy does not elevate the risk of estrogen-sensitive cancers but it does lower the risk for several other types of cancer.  Conclusion: soy is a safe and wonderful source of complete protein.  The only downside to soy, it seems, is that most of the soy now grown in the U.S. has been genetically modified.  Try to buy only soybeans or soy-based products that are labeled ‘organic’ and/or ‘Non-GMO.’ ​

READ ON: Healthy Animal Protein

In April, a presentation at the American Society for Nutrition's Scientific Sessions at Experimental Biology 2016 showed that certain dietary habits are associated with increased risk for breast and prostate cancer (April 2-6, 2016; San Diego, CA). More than 3,000 adults were followed for more than 20 years.  About 25% were diagnosed at some point during this time with cancer. Those who regularly consumed carbohydrate-dense foods (CDFs) such as fruit juices and other sugary soft drinks had three times as much prostate cancer as those who took in less. CDFs (foods that cause spikes in blood sugar) were associated with increased risk for prostate cancer.  Men who regularly consume processed foods (bread, pizza, deli meats, hot dogs, hamburgers, etc.) had double the risk for prostate cancer. 

Women whose diets were high in vegetables, whole fruits, and legumes were two-thirds less likely to develop breast cancer than women whose diets were high in CDFs like whole wheat bread, cereal, pasta, juices, and sweets.

Many studies have shown that carrying extra belly fat and diets high in CDFs or red meat increase risk for diabetes, strokes, heart attacks, sexual dysfunction, and various cancers especially of the digestive system.  (British Journal of Cancer, Jan 4,2011;104 (1): 6–11 and European Journal of Clinical Nutrition, 2007;61(Suppl 1):S112–S121).  Diets high in CDFs cause belly fat to accumulate.  Belly fat, CDFs and red meat all cause inflammation and inflammation is a driver of all forms of chronic disease, including cancers.

How Inflammation May Cause Cancer
When a germ gets into your body, your immunity recognizes that the germ cells have proteins on their outer surfaces that are different from your body's own cells. Your immunity produces cells and proteins that attack and kill these invading germs. However, as soon as the invading germs are gone, your immunity is supposed to calm down and stop producing all the proteins and cells that did the attacking and killing. Chronic inflammation means that your immunity stays active and starts to attack and damage your own cells and the DNA/genetic material inside them.
Normal cells live only a certain number of days and then die. Our cells are constantly being replaced by new, healthy cells.  However, if your immunity damages your DNA, the cells may be changed so they forget to die and try to live forever, which is cancer. The "immortal" cancer cells overgrow and invade other tissues to destroy them and kill you. For example, breast cancer cells do not kill you as long as they stay in the breast, but the breast cancer cells can become so numerous that they spread to your brain, lungs, bones and other tissues and kill you by destroying these essential tissues.

High Blood Sugar Causes Inflammation
The same cells and chemicals that kill germs also start the healing process, so damage to any tissue in your body turns on your immunity in the same way that infections do and therefore can cause inflammation. When blood sugar levels rise too high, sugar sticks to the outer membranes of all the cells in your body and damages them, causing sugar-protein-fat complexes called AGEs or plaques.  Plaques in arteries cause atherosclerosis, plaques in joints cause arthritis, and plaques in the brain cause dementia.  

All the harmful effects of diabetes, such as impotence, dementia, blindness, deafness, heart attacks and cancers, are caused by high blood sugar turning on your immunity, and you don't have to be diabetic to suffer this damage. A review of the world's literature shows that non-diabetics with high blood sugar levels suffer a marked increase in breast, colon, liver, stomach, pancreatic and endometrial cancers. (Diabetologia, September 8, 2014). Furthermore, high blood sugar levels cause high insulin levels that also increase cancer risk (JCI May 2013;4(3)). High blood sugar levels can be caused by any of the high-glycemic-load foods, including all sports drinks, protein bars, granola, fruit juices, baked goods (including whole wheat and whole grain breads, muffins, cereals), white rice, potatoes, pastas (including whole wheat and whole grain pastas), and sauces and batters made with flour (Cancer Epidemiology, Biomarkers & Prevention, March 3, 2016). Other studies show that high blood sugar levels are associated with increased risk for prostate cancer (Horm Cancer, April 2016;7(2):75-83) and breast cancer by causing inflammation through the 12-Lipoxygenase (12-HETE) pathway (Cancer Res, Jan 1, 2016;76(1);24–29).

​Overweight Causes Inflammation
Full fat cells also produce the same cells and chemicals that turn on your immunity, which is why obesity is a major cause of inflammation (International Journal of Cardiology, April 14, 2016;215:318-324). Many studies show that obesity causes inflammation by increasing interleukin-6, BP and insulin insensitivity (International Journal of Cardiology, April 14, 2016;215:318-324 andJ Clin Endocrinol Metab, Mar 2001;86(3):1154-9). Overweight causes high blood sugar levels; blood sugar levels rise with increases in body weight, BMI and waist circumference (Cardiovasc Diabetol, Feb 6, 2012;11:13). Excess weight also increases risk for metabolic syndrome and diabetes (Nutrition, Metabolism & Cardiovascular Diseases, November 12, 2015). Storing fat in your belly raises markers of inflammation: C–reactive protein, leptin and insulin (Nutr Metab Cardiovasc Dis, February 2016;26(2):114–122) and many different cancers (Cancer Prev Res, March 2013 6; 177). Excess belly fat is directly caused by diets high in CDFs.  

Healthy diet
For two million years, humans evolved and adapted to a diet that is high in fiber, moderate in protein, low in fat, and very low in CDFs.  I call this the Human Diet.  For more information on the Human Diet, please contact the office and we will send you a copy of part I of my series on health: Health Part I; Nutrition which can be sent to you by email.  Or simply link to the article here.

Plant protein is less abundant.  There are several plant sources of protein but the only plant source of complete protein is soybean.  That’s one of the reasons that it is such an important part of vegetarian and vegan diets, and one of the reasons that I recommend soy products be included as a dietary staple.  Soybean is a very versatile plant food that can be eaten on its own (edamame), added as a healthy filler to other foods, or used to make soy milk, tempeh, and tofu (which is made by boiling soy milk).  Tofu can be soft and delicate or firm and sturdy, and it tends to take on the flavor of whatever it is cooked with, enabling it to be used in a wide variety of ways including as a substitute for meats of various kinds.  ​

Other sources of plant-based protein (which are not complete proteins) include: beans, nuts, lentils, hemp, chia, seeds, quinoa, and spirulina.  But not all plants are necessarily healthy foods, even if they do contain protein.  As you will read later, a lot of today’s GMO plants are very high in carbohydrates, and CDFs, as stated above, make blood sugar levels soar.  Keeping our blood sugar levels relatively stable may be the single most important of the nine Rules of Healthy Eating.  We should try to limit carbohydrate intake to about 15g per meal.  More about this later, but as in illustration, one cup of quinoa contains 24g of protein but a whopping 109g of carbohydrate!  Compare this to a cup of leafy greens like spinach which provides about 1g of carbs.

READ ON: Is Soy Healthy?

In the Human Diet about one third of our calories should come from protein.  Children and young (still growing) adults, as well as adults with special nutritional needs (such as endurance athletes), may require even a little more protein for growth and the formation and restoration of healthy muscles, joints, bones and connective tissues.  If you are eating animal-based protein, the thing you most want to consider is this: How healthy was the animal whose proteins you are eating?  Pasture raised, organic animals and animal products are healthy sources of protein to which we are well-adapted.  However, commercially raised animals are routinely confined in small spaces where they are made to suffer.  This causes their bodies to produce high amounts of stress hormones.  They are also fed a high carbohydrate diet (corn and grains) to make them big and fat.  What’s more, this feed is routinely laced with hormones to make them even bigger and with antibiotics to keep infectious diseases at bay.  Such animals are not particularly healthy and their flesh, fat, and milk reflect this.  If you eat meat, eggs, or dairy, it is important to choose healthy animals.    

​READ ON: Plant Based Sources of Protein

Red Meat and Cancer:

In addition to its role in promoting heart disease, numerous studies have also linked red meat consumption to cancers of various kinds, and especially colon cancer.  All mammals except for humans contain on the surfaces of their cells a sugar, called Neu5Gc.  When humans eat the meat of cows and pigs, we are consuming Neu5Gc, causing this sugar to stick to the outsides of our cells.  Because it is not a sugar that humans are meant to have stuck on our cells, our bodies mount an immune response against the cells with surface Neu5Gc, making antibodies that attack those cells.  Daily consumption of red meat causes an ongoing immune response resulting in a state of chronic inflammation.  Chronic inflammation is now understood to be the chief driver of heart disease, diabetes, and cancers, among other chronic diseases.  Dr. Ajit Varki, at UCSD, has shown that this chronic inflammatory state results in spontaneous cancer tumors in mice genetically engineered to not produce Neu5Gc (like humans) when they are fed meat.

There are many reasons to cut down or avoid eating meat, including animal cruelty, pollution effects of cattle, and the various hormones, antibiotics, and grain feeds on which commercial cattle are raised.  My recommendation for optimal health is this: if you are going to eat red meat, do so no more than one to three times per month, and buy only organic, pasture raised, animal-centered, grass-fed beef.   ​

​READ ON: How Healthy Was the Animal Whose Proteins You are Eating?

Begin reading from the beginning of this series about Food and Nutrition

A few words here about red meat.

 We have all heard for decades that red meat is unhealthy.  The original recommendation by the medical community to reduce red meat consumption was based on the (now false) assumption that dietary animal fat was the chief cause of obesity, and heart disease.  However, while it is now clear that animal fat (including the fat in beef) is actually healthy in small amounts, good studies continue to link regular consumption of red meat with increased risk of cardiovascular disease.  Why?  

Red meat is high in a particular compound called carnitine which is synthesized from two amino acids (methionine and lysine).  Certain gut bacteria feed on carnitine producing a waste product which is turned into something called TMAO.  Recent studies have shown that high levels of TMAO cause tiny puncture wounds form along the cells lining our arteries (the endothelium).  These endothelial wounds are the initiating event for plaque formation (atherosclerosis).  Humans and animals who eat red meat regularly have higher levels of TMAO which is directly associated with atherosclerosis and increased risk of heart attack.  

Should we avoid carnitine then?  Not so fast.  Carnitine is an essential compound used by all cells of the body for energy and for fatty acid metabolism.  It  helps muscles heal after injury and intense workouts.  Carnitine plays a vital role in health.  But like any healthy substance, too much of it can become a problem.  Too much carnitine over time results in too much TMAO.   

TMAO levels do not go up after eating red meat in people who only eat it occasionally.  Vegans given meat/carnitine do not show a rise in TMAO levels because the bacteria which feed off of carnitine die off after prolonged periods without carnitine to sustain them.  Animals fed a diet rich in carnitine over time show the same rises in TMAO and the same endothelial ulcers as do humans.  However, if these animals are given bacteria-killing antibiotics prior to being fed carnitine, TMAO levels remain low, supporting the idea that gut bacteria are the source of the TMAO.  

In a nutshell, certain gut bacteria feed on carnitine which leads to production of TMAO, which in turn damages our blood vessels.  This is what makes regular consumption of red meat (the most potent source of carnitine) a risky dietary behavior.  

READ ON: Red Meat and Cancer

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