The most practical/cost effective point of care ultrasound (POCUS) device as of 2020: Butterfly iQ

From CNN:

"Handheld devices also cost much less than traditional ultrasound machines. The ones sold by Butterfly, GE and Philips range in price from around $2,000 to $5,000, whereas traditional devices can cost tens or even hundreds of thousands of dollars.

The Butterfly iQ is currently equipped for 19 different types of scans and tests. A "major" limitation is the inability to perform the spectral Doppler test used to identify some more acute heart conditions."



The Butterfly iQ costs $2,000. There is a first-year fee of $400:

https://store.butterflynetwork.com/us/en/iq/configure/

References:

https://www.cnn.com/2020/07/08/tech/ultrasound-machine-handheld-coronavirus/index.html

Best longevity app as of 2020? LifeExtend, and it's free

Among the longevity apps, LifeExtend is the clear winner as of May 2020. The app is evidence-based, has helpful references and it is free: https://lifeapps.io/apps/life-extend/

It is backed by the physician/entrepreneur Don Brown (LifeOmics) and the University of Indiana, so it is not going away next year.

The app is packed with features and you can dig deeper in any of the domains/5 pillars when you have time.

LifeExtend is based on 5 scientifically proven health pillars, they appear as 5 columns and you collect points in each pillar. It looks like a game but the benefits are real.



The app tracks the big 5 longevity practices:

1. Sleep. Give yourself an 8-hour sleep opportunity every night. Aim for at least 7 hours of sleep per night. Oura ring ($300) or Withings under mattress sensor ($99) can be very helpful. You will quickly realize there is a big difference between hours in bed and hours of sleep. 8 hours in bed will give your approximately 7 hours of sleep. Try to go to bed by at least 10 pm to maximize deep sleep which typically occurs in the earlier hours of the 8-hour sleep opportunity. Sleep is the most important longevity practice. Mathew Walker's book Why We Sleep is an essential reading. You can watch his talks on YouTube before buying the book.

2. Nutrition. Try to eat at 5 servings of vegetables per day. Fruits are OK but from a longevity perspective they are not as good as vegetables. Consider a whole-food plant-based diet. Plants stimulate hormesis, more details are available in Dr Mattson's article on the topic in PubMed. Simply cooked, minimally processed meals are the probably best choice. Valter Longo's longevity diet is a good starting point. You can watch his talks on YouTube before buying the book. Most centenarians have BMI around 20.



Interventions that promote longevity, remembered by mnemonic: DEEP purple - “eat colorful plant foods: Dietary modification, Exercise, active Engagement, Purposeful living (click here to enlarge the image).

3. Time-restricted eating/Intermittent fasting. Packing all nutritional intake into a window of no more than 6-8 hours (or intermittent fasting for at least 14 hours per day) can be helpful. In addition to time-restricted eating (TRE), consider the Fasting Mimicking Diet (FMD, Prolon (TM)), developed by Dr Longo. Dr Mattson's NEJM article from December 2019 is an excellent summary of the benefits and the practices. Time-restricted eating (TRE) is the more accurate term for the time of fasting charted in the Life Extend app vs. intermittent fasting.

4. Physical activity/exercise. Get at least 30 minutes of moderate to intense physical activity. Walking may not be enough. As we get older, low impact exercises take priority. Exercise is defined as at least a 10-minute continuous activity. HIIT (high intensity interval training), with no jumping or equipment, is a very practical choice, see an example of a 15-minute HIIT workout below:



5. Stress management/mindfulness. Engage in meditation or other stress reduction activities. LifeExtend integrates the meditation guides within the app. Wim Hof Method free app is an excellent starting point as a relaxation/active mediation practice.Wim Hof adds an additional hormetic stress via cold exposure (optional).



Satchin Panda's app works in a similar way to LifeExtend, adding data about nutrition, sleep, exercise, but the interface has a different focus: myCircadianClock | Salk Institute https://mycircadianclock.org

More and more employers have an activity/healthy weight requirements pushed to the employees in order to pay lower insurance premiums. A typical example would include 5,000 steps per day, no obesity, hypertension, diabetes or asthma. LifeExtend can help you achieve some of these goals on your own.

References:

Intermittent metabolic switching (IMS) via fasting: is it for you and how to do it? 

Fasting mimicking diet (ProLon) by Valter Longo, PhD

Exceptional longevity: why some people live to be more than 100-year old  

https://medium.com/lifeomic/a-vision-of-life-extend-a-powerful-precision-health-mobile-app-b00e9e443bbf

https://www.youtube.com/watch?v=8kCRJLSUit4

Check LifeOmics' playlists for more info: https://www.youtube.com/channel/UCfOiisp_IiWB6bWJtgzh7OQ/playlists

Coronavirus: Lockdown's heavy toll on Italy's mental health

Coronavirus: Lockdown's heavy toll on Italy's mental health - BBC News. What started as a physical health emergency is morphing into a psychological one:



From BBC: "Italy’s coronavirus death toll is the second highest in the world, and its lockdown is the strictest and longest in Europe.Doctors say both things are creating a mental health emergency. The BBC has been given access to a psychological support centre run by the Red Cross, where staff say they’re overwhelmed by calls from people struggling. Psychologists are warning that Italy is not equipped to deal with the crisis, and that the rest of Europe must prepare. If you've been affected by a mental health issue, help and support is available. Visit Befrienders International for more information about support services in your country, or visit BBC Action Line. Film by the BBC’s Europe Correspondent Jean Mackenzie, produced by Sara Monetta, filmed and edited by Andy Smythe."

Psychiatrist Jud Brewer offers helpful tips how to deal with the multiple negative emotions surrounding the COVID-19 pandemic: How to Break the Coronavirus Anxiety Cycle

Not a bad summary of the current COVID-19 quarantine situation by the Rolling Stones:

"ALWAYS HAD THE FEELING
IT WOULD ALL COME TUMBLING DOWN

LIFE WAS SO BEAUTIFUL
THEN WE ALL GOT LOCKED DOWN

IT ISN’T ANY FUN
IF I WANT A PARTY
IT’S A PARTY OF ONE

PLEASE LET THIS BE OVER
NOT STUCK IN A WORLD WITHOUT END"



The song was recorded in 2019, before the COVID-19 pandemic.

Wim Hof Method decreases IL-6, can it prevent IL-6-induced cytokine storm in COVID19?

A subgroup of patients with severe COVID-19 may have a cytokine storm syndrome.

A cytokine profile in severe COVID-19 disease includes increased interleukin (IL)-2, IL-7, granulocyte-colony stimulating factor, interferon-gamma inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1-alpha, tumour necrosis factor-alpha, and IL-6. Mortality might be due to virally driven hyperinflammation.

Anti-IL-6 antibody tocilizumab (IL-6 receptor blocker) has been used in patients with COVID-19 pneumonia and elevated IL-6. Other agents, such as sarilumab and siltuximab, which also target the IL-6 pathway, are being evaluated in clinical trials.

Wim Hof Method decreases IL-6, can it prevent IL-6-induced cytokine storm in COVID19?

Traditionally, both the autonomic nervous system and innate immune system are regarded as systems that cannot be voluntarily influenced, hence the name "autonomic", independent, from voluntary influence.

The mainstay of the Wim Hof Method is a 20-minute meditation centered around a breathing technique (cyclic hyperventilation followed by breath retention). In a small study of 24 patients (12 in the intervention arm vs 12 controls), levels of proinflammatory mediators TNF-alpha, IL-6, and IL-8 were lower in the intervention group. There was a large increase in the IL-10 levels in the intervention group. See figure 4 here: https://www.pnas.org/content/pnas/111/20/7379/F4.large.jpg, https://www.pnas.org/content/111/20/7379

A video of a study participant from the article is embedded below:



You can try the Wim Hof Method for yourself via his app at the link below: https://www.wimhofmethod.com/wim-hof-method-mobile-app

All the usual disclaimers apply (linked in the sidebar of this website).

References:

COVID-19: consider cytokine storm syndromes and immunosuppression. Puja Mehta et al. Lancet, 2020,
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext

Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Matthijs Kox et al. PNAS May 20, 2014 111 (20) 7379-7384; first published May 5, 2014 https://doi.org/10.1073/pnas.1322174111

Related podcast: https://www.youtube.com/watch?v=YfAgSusi6t0

How to Break the Coronavirus Anxiety Cycle

From the psychiatrist Judson A. Brewer, M.D., Ph.D. in the NYTimes:

Anxiety and its close cousin, panic, are both born from fear and uncertainty. We have plenty of that with the current COVID-19 pandemic.

If information is lacking, our prefrontal cortex lays out different scenarios about what might happen. Some of these scenarios can be pretty scary.

Anxiety is contagious. The spread of emotion from one person to another is called social contagion. "People can sneeze on your brain", says Dr Jud. "Our own anxiety can be cued or triggered simply by talking to someone else who is anxious. Their fearful words are like a sneeze landing directly on our brain, emotionally infecting our prefrontal cortex, and sending it out of control as it worries about everything from whether our family members will get sick to how our jobs will be affected."

To break the anxiety cycle, do 2 things:

1. become aware when you are getting anxious or panicking and what the result is.
2. bring in the “bigger better offer” (BBO).

What is the “bigger better offer” (BBO)? Your brain will choose more rewarding behaviors simply because they feel better. Replace old habitual behaviors — such as worry — with those that are naturally more rewarding.

An example: If you notice that your touched your face, and start to worry: “Oh no, I touched my face, maybe I’ll get sick!”, instead of panicking, take a deep breath and ask: “When was the last time I cleaned my hands?”. Think. “Oh, right! I just washed my hands.” Here, we can leverage certainty: If we’ve just washed our hands, and haven’t been out in public, the likelihood that we’re going to get sick is pretty low."



Dr Jud: "Understanding these simple learning mechanisms will help all of us “keep calm and carry on” (which is how London dealt with the uncertainty of constant air raids in World War II) instead of getting caught in anxiety or panic in the coming days, and whenever we face uncertainty."

You will understand this more clearly if you watch some of Dr Jud's videos below. He has a coronavirus playlist:

https://www.youtube.com/watch?v=w4NwsyXRbNw&list=PL6sRqjtLfiTTni7oXKpSj2cQ9290lkpKH

There is also a longer explanation here: The 3 WAYS To Keep Coronavirus ANXIETY From Going VIRAL | Judson Brewer & Lewis Howes:



References:

A Brain Hack to Break the Coronavirus Anxiety Cycle https://www.nytimes.com/2020/03/13/well/mind/a-brain-hack-to-break-the-coronavirus-anxiety-cycle.html

https://twitter.com/judbrewer