Summary
Dr Sam Manger from The GP Show joins me today with loads of practical advice for teachers working throughout the Covid-19 pandemic.
Dr Sam is a GP on the Sunshine Coast with special interests in lifestyle medicine and mental health. He is also the President of the Australasian Society of Lifestyle Medicine.
In this episode:
- What is Lifestyle Medicine?
- What are the risk factors for moderate to severe Covid-19 infection?
- What measures should teachers take to physically protect themselves against Covid-19?
- Which foods and/or supplements should teachers include in their diets to boost immunity?
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GP Chat – Teacher Health and Wellbeing during Covid19 – Full Episode Transcript
Bronwyn: I’m joined by Dr Sam Manger who hails from the gorgeous Sunshine Coast hinterland. Dr Sam is a medical practitioner and educator and he hosts a brilliant podcast for medical professionals called The GP show. Sam is also the president of the Australasian Society of Lifestyle Medicine. Welcome Dr Sam to, For the Love of Teaching today. We’re going to look into some ways that teaching professionals and school support staff can look after their health and wellbeing during the Covid19 crisis. Hi, thanks for being here!
Sam: Hello Bronwyn. Thanks for having me.
Bronwyn: You work within the discipline of lifestyle medicine. So could you just explain for the listeners, what is lifestyle medicine in a nutshell and why is it particularly valuable in the midst of a pandemic like we are in now?
What is Lifestyle Medicine?
Sam: Yeah, sure. Uh, well I’m a GP and, and obviously we practice lots of things and lifestyle medicine is where my area mental health and lifestyle medicine and my two areas of, I suppose expertise and lifestyle medicine is a whole of person and whole system approach to health. So that might be using evidence based lifestyle interventions like food movement, mind activities, connections, sleep, uh, stopping smoking, alcohol obviously as medicine combined with new ways of like practicing medicine. So incorporating behaviour change technique, training, group appointments, online platforms. And the point is, is we’re trying to address the whole, the whole, uh, determinant and stream of health and disease. So not just from individual choices of food, but all the way up to the food system in general. Because what determines individual choices often what happens in the larger society and social setting and to social determinants like wealth gaps and policies and environmental, um, aspects.
What are the risk factors for moderate to severe Covid-19 infection?
So we’re trying to support and approach the roots of wellbeing as, so you go from disease to thriving. And it’s really important to say it’s not just about prevention, which is obviously important, but also about reversal because we know that some of our most chronic and common diseases like diabetes, heart disease, high blood pressure, obesity, some lung disease, dementia and even depression, um, are actually treatable and reversible with these lifestyle approaches. So they’re extremely effective. And like I said, it’s not just about physical health, it’s about mental health as well, which we can go into a little bit later if you like. And this is really relevant in always, but in particular in the midst of a pandemic because the risk factors that push people from having a mild infection or mild covert infection to a moderate or severe one is often the presence of chronic diseases, like whether they smoke, whether they’re overweight or high blood pressure, their heart or lung disease, et cetera.
Um, and so if you can reverse that, treat that well, then you reduce their chances of going to a severe infection. And also because mental health is a major issue right now. Um, I’ve seen it all too commonly. It’s actually the number one reason people present to a GP has mental health concerns. And so I was already dealing with it a lot. But now with, um, financial struggles, social disconnection, stress and fear, um, it’s just such a, I mean it’s most of my day at the moment. And so these things are also good for mental health and so it’s looking after the whole person and that’s the approach we take.
Bronwyn: Yeah. Great. That’s so interesting that you mentioned that those chronic illnesses, definitely risk factors for people with Covid in particular. Um, because in teaching and an education, our teachers come from such a wide range of backgrounds. They’re in varying locations, geographically, age stages, but also the types of employment that teaches are in a large proportion of our workforce. Uh, casual and contract teachers who are probably suffering through loss of income, loss of work, and really great that you look at both of those things, the physical and the mental together.
What measures should teachers take to physically protect themselves against Covid-19?
Sam: I’ve said it before in my past podcast, but I think nurses, teachers and farmers are probably the three most important professions in my opinion. And um, but sadly the three least paid. And um, and so having some stability and health and what I can do for that community, I’m more than happy to do.
Bronwyn: Thank you. So I’m looking at teachers who are still at work in the classroom at the school, so basically frontline workers now it’s a little bit tricky to go into this and we have had a chat, um, before we started recording about protection and making sure that they’re safe at work in a physical way. There are directives coming down from the state departments and also from the teachers’ unions in their respective states as well. But it’s a tricky kind of situation because as far as we know, our students and our colleagues are healthy. Obviously um with Covid, the tricky part about that is that the incubation period is someone can appear healthy and not be, but social distancing isn’t always possible in educational settings.
So, I’m an Early Years teacher. So when I think about my time in a classroom, little kids are very physical, physically demanding, but also very lacking in social and emotional skills to distance themselves. So there’ll be very on top of the teachers and also students in special needs classrooms have particular support needs with their physical learning as well. So how can teachers best attempt to protect themselves from Covid19?
Sam: So I really feel for, for teachers at this point in time, because I can understand kids over 15 and reasonably easy to social distance and manage, but kids under that I imagine is pretty much impossible. Um, so I guess, um, there’s three things. One is just looking after yourself as we will talk about a little later in the sense of doing everything you can to optimise your own immune system so it can deal with the challenges that are currently is being faced, both physical and mental. Um, and then when it comes to social distancing, uh, I can’t really give advice in the sense of what teachers should be doing from an educational department point of view. Um, because that, that’s, that’s a tricky question. But, um, when it comes to why we should be social distancing. So the big thing with it is that Covid in particular is spread mostly via droplets.
And that means the secretions that come out of people’s mouth. So whilst most people are not acutely infected and coughing, they’re unlikely to spread it beyond about a meter. And so hence where the social distancing of 1.5 to two meters, this has come in because it’s very unlikely those droplets are going to actually get near a person or go onto a surface of concern. Um, if they not coughing and, um, they’re people are staying away from them. A meter and a half. The reason we’re so keen on washing hands, which is so crucial is because the way that the virus gets into us is let’s say a person coughs those droplets with the virus and it go onto a surface. Then we come along and touch the surface and then we would do what almost every human does, which is touches their face about 20 times a minute.
Um, and then that would go into the mouth or the eyes, which is where Covid enters our body. So if we can break that transmission cycle as much as possible, meaning that we spread out as much as possible, obviously anyone with a fever or coughing should obviously be excluded. Um, and then washing hands and surfaces as much as possible. We’re breaking that transmission cycle up as much as we realistically and practically can. But, and that’s the obvious advice that’s being given by, uh, authorities when it comes to social distancing in as an entirety. Um, do you want me to talk about that or not?
Bronwyn: Yeah, that would be amazing. Yeah, because I mean, teacher, we, uh, some, some students would argue that this isn’t the case, but we do have lives outside of the classroom and outside of school and we do have to still go grocery shopping and many of us have families of our own, so we’re concerned about their wellbeing and, um, not having visitors or making different arrangements. So yeah, I guess that’s part of teachers’ lives in an overarching kind of way.
Why Does Social Distancing Matter?
Sam: Sure. So when it comes to social distancing, it’s sometimes can be helpful to identify and highlight the numbers because then that informs why we recommend people socially isolate themselves as much as possible. And it’s difficult in these environments like the school. But if a person, let’s say just goes on about their life and they’ve got the Covid infection, then in five days they’re going to infect two and a half people. And in 30 days that will extrapolate to 400 over 400 people becoming infected. But if we actually reduced our contact by 75%, so that’s not 100%, that’s 75%. Then in that total 30 days, we’re only going to affect 2.5 people. So instead of over 400 people, it’s only gonna be 2.5 people. So there’s an enormous benefit, um, to that social distancing and why it matters so much when it comes to masks, which is probably one of the most common questions I get.
Should Teachers Wear Masks or Other PPE?
And that is being asked. ‘Cause there’s so much confusion and disagreement between major bodies. I mean, the World Health Organisation says they’re not really necessary um, outside health professionals and people who are infected. And then the CDC is recommending it, that if you’re inside or around people, you should be wearing masks all the time. Well, really it comes down to three things. It comes down to the type of mask, whether you’re using it properly and whether you’re wearing it to protect yourself or you’re wearing it to protect others. And there are three questions that we’ll go through the info and then that will inform how people decide. Um, because there is no clear yes or no. So there’s types of masks. Your DIY masks, whether it’s like scarves or homemade things, there’s surgical masks and then there’s the proper masks. Now obviously the N95 masks, are the things that are fitted very well, you need to shave your face, um, so that it doesn’t get in there.
The things that really work are preventing people getting Covid, um, from anyone else around them. The other two, uh, DIY ones, the surgical ones aware the contention lies. And we really, we should be saving N95 masks for health professionals. So us in the general public, um, uh, wondering, you know, should we be using the other ones? So this comes down to whether you use it properly and then how much benefit it gives. So one of the concerns that like, let’s say the world health organisation have highlighted, is that they’re worried that people walk around with masks that aren’t met effective at stopping people getting the infection. So that’s these DIY and surgical masks. Then people have a false sense of security. They won’t adhere to the really important things like hand washing, social distancing, um, recommendations. And so the infection will spread.
And, and that has actually been shown that when we follow people who were masks, the general public, less than half of them actually wear it appropriately. So they might cover their mouth but not their nose. They might touch the mask all the time, which then means they’re now out on their hands and, and, uh, and they might, you know, put it, they might just get rid of it and throw it down on the ground somewhere. So this is a problem cause that’s actually going to spread the infection. So people aren’t using it properly, then it actually becomes a hazard, not, not a help. Now when it comes to whether people are going to, for others or yourself, this is where it comes down to, CDC recommendations are kind of similar to this in the sense of if you’ve got the infection or you’ve got a infection, all masks, whether they’re DIY surgical ones are quite good at preventing you, spreading it to others.
So it’s catching your own droplets out of your mouth and stopping it, going to other places, hands, surfaces, et cetera. So for that reason it’s quite good. Are they good at preventing the infection coming to you? Not really. No. Because it can enter through the sides. It can enter through your hands, it can enter through your eyes and those sorts of things. So it’s not that good at preventing getting the infection, but it’s good at preventing you spreading it to others. Now the CDC have made that recommendation because, I mean America is a place where there’s lots of public transport, people very close together. Um, in certain situations, and I guess this is true for schools as well. So they said, well, you might as well just wear it, but you have to use it properly, and if you’re not gonna use it properly, there’s no real point. Um, so I think their real recommendation has been for close proximity, grocery stores, public transportation, that sort of stuff. Um, outside that, um, it’s probably no real benefit to use.
Bronwyn: And so then there’s probably, in your opinion, no need for teachers to do this as a practice, but if they feel comfortable doing it, then it’s probably okay as long as they’re aware of the, the correct way to wear one of these DIY masks.
Sam: But yes, I would say that as a general rule, if you’re around people without symptoms, they’re trying to do what they can and you’re doing what you can and no one’s sick, then you probably don’t need a mask. But at the same time, if you’re going to use it properly and dispose of it properly, then there’s no harm in using it either.
Bronwyn: Yeah. Great. Okay. Well, thank you for clearing that up for us. It’s just piecing together all this information. And that’s great, Dr Sam, that you’re able to fill in some gaps for us. So same on your own podcast, The GP show. You just released an episode about wellbeing during the pandemic for doctors and healthcare workers themselves. Um, but it would be great for teachers to listen to you too, cause I found it really interesting. But what are some of the ways that teachers can boost immunity to reduce our chances of more severe and complicated infections should they come about? So some quick wins that we can use to boost up our own immunity.
Which foods and/or supplements should teachers include in their diets to boost immunity?
Sam: Yeah, sure. Well, there’s lots of areas and like I said before, you know, we can break it up into food and to movement, to sleep into supplements, into connection and an outdoor and natural exposure. So I might just sort of rattle through those. Um, and then highlight how each of those are important as the quick wins. Well, I don’t know about quick, everything that matters usually take some sense of effort. Um, and I’m not a huge proponent of supplements, but obviously they do have their place and they are unnecessary sometimes. But my preference is if you can get those things from food, you should not just because it’s better and things don’t come in, say let’s take vitamin C for example. A Kiwi is very high in vitamin C and it’s actually been perspective, um, trials showing the kiwifruit actually reduces the severity and length of a viral infections.
Now is that because it’s high in vitamins eating? Maybe, but there could be other things in Kiwis that we don’t really know about. So, um, I would recommend at the same time you’re supporting Aussie farmers, um, uh, by, by buying local. So I would recommend that people go for the food source, um, rather than taking a supplement as a general rule. But obviously there are exceptions to that. So if we, if we sort of come back to food, the first thing I’d say is that you want whole food nutrient dense. Okay. Often it’s, it’s um, mostly plants, but there are obviously some very good sources of animal products are usually free range or grass fed meats or wild game like kangaroo or fish or oysters and things like that. They matter for a variety of reasons. Um, number one is that good food, uh, like a Mediterranean diet or any really any, a whole food diet, whether it be low fat or low carb.
And I can spend hours talking about all that stuff. Um, is that it’s anti-inflammatory and there have been papers from Harvard, there’s been a number of papers showing that good food is anti-inflammatory and this is really important for a number of reasons. One, inflammation is not generally good. That’s what causes pain. But it’s also what causes things like, so let’s say if you take a common infection that your, that your teachers, your, your audience will know a lot about which is croup cause they would see kids all the time with croup. And, um, this, this is interesting because the way we treat croup is actually with steroids, which is enhanced, very strong, anti inflammatory because the damage and the pain from croup is from your own body’s immune system causing inflammation. And this is what we see in Covid as well about day seven to nine, um, of people who have the severe infection of coven actually have a sudden, um, what’s called cytokine response.
So their own immune system suddenly switches on big time and flushes the body with inflammation and then that’s when they have sudden severe lung inflammation and they can’t breathe properly and that’s when they need ventilators and things like that. So you want to have an immune system that is a well-regulated and well modulated, um, that won’t suddenly cause this major damage. So whether it’s a common cold like croup or it’s a severe infection, having a good immune system, which is good at managing inflammation, not going to go over the top one too much under is about right. And if we look at say, studies with asthma, where we’ve given people prospective trials, good quality trials where we ask people to go, okay, you eat five serves of fruit and veggies day, whole foods, you just keep eating what you’re eating. Standard Australian diet. Jeez. Usually one serve of fruit veg a day or maybe two.
93% of Australians don’t eat the recommended number of vegetables a day. So that’s the vast majority. Um, we’ll see what happens. And the people who ate five serves of fruit and veg halved their exacerbation rates of asthma and improve their lung function. And that’s because of the inflammation in the lungs went down and that’s what the medication is supposed to do. So you can achieve that through your diet. The other thing about food is that obviously when it comes to, um, there are things in food, vitamins and minerals and proteins, carbohydrates, fats, et cetera, and you can get good versions and bad versions of those fats and carbohydrates. But if your whole food, it’s going to be good and we need those building blocks to operate. I mean, we are a very complex machine. We’re not a machine, obviously we’re a complex biology, but if you’re going to run a car, if you have bought a Ferrari or a Tesla, you’re not going to put in Coke into the machine or you’re going to put the best, best petrol, the best oil that you can because you want to look after it.
And it’s exactly the same with our bodies. So if we want the best out of our body, we’ve got to give it the best. And so it took it for it to run smoothly and well, it needs those vitamins and minerals. So I mentioned vitamin C before and there is, you know, not a lot of evidence to be honest, that that’s, that’s um, as a supplement, very effective for reducing the length and severity of infections. There’s a little bit, there is some studies looking at high V vitamin fusions for those with sepsis or major bacterial infection or a major viral infection and they are looking reasonably promising. Um, but there’s other studies that say zinc that shows that can shorten the duration and severity. And what comes from zinc? Well, pumpkin seeds, cashews, oysters, they’re in zinc. We know that Selenium seems to be quite effective as well.
Studies Show Selenium Can Help Reduce Severity of Viral Infections
Well, what’s weird, where do you get your selenium from? Brazil nuts to Brazil nuts a day is enough Selenium to meet your requirements. Um, and very interesting. There’s been some really fascinating studies when they look at say influenza virus and a few other types of virus, um, that have quite different the different types of viruses. And they showed that the virus actually mutates. Um, and the infectivity of it, meaning how much damage it’s going to do, um, actually changes depending on the host that infects. And those who are deficient in selenium have a much more virulent, where much more damaged causing version of that infection. So these are things that we actually do know can make a significant difference. And then when we look at all the other stuff, and I could talk about this for how is obviously, but when we look at, let’s say diabetes or like I said, we can reverse that. I’ve reversed diabetes many, many times. You might patients, it’s not a necessary condition. I’m talking about type two diabetes primarily there and, and when we look at our gut microbiome, which obviously has a very important role in our own defence and immune response, well obviously good food equals good gut microbiome. So there’s a lot within just whole foods, mostly plants. Um, you don’t need to worry too much beyond that, but if you want some specifics then I’ve given you a few.
Bronwyn: Yeah, really great. I think that’s probably a really good time for teachers to assess their nutrition and what they’re doing, um, in the way of yeah, their diets at the moment because we are spending quite a lot of time at home and I know that in my case there’s a lot of snacking going on. It’s just been a start and it is definitely time to take check of what is actually going on. Um, and make sure that yeah, we are getting that high quality nutrition, um, from the whole foods that we know is important. We teach our students about this all the time, but it’s really great to hear the connection between that and the evidence based information that doctors have been able to find out. Dr Sam, thank you so much for joining me on the podcast today. I really appreciate your time.
Sam: My pleasure. It’s been wonderful. Thank you for having me.
Bronwyn: Thanks very much. And if you would like to visit Dr Sam’s website, it’s at theGP show.com and Sam has blog posts, show notes, and all of his episodes are available there. So don’t forget to subscribe to the podcast while you’re there.