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As Doctors Race to Frontline of COVID-19 Crisis, Total Access Medical Guarantees 24/7 Access to Physicians Offering Immediate Patient Care to Meet…

As medical professionals rush to the frontline of the coronavirus outbreak, primary care providers are needed to handle emergency medical concerns and pre-existing health issues. What happens if a person is sick or in risk and they cannot speak to or see their doctor?

Total Access Medical (TAM), a direct primary care service with more than 15 years-experience, helps patients receive the immediate medical attention they need in order to navigate this complicated and confusing pandemic. One of the first affordable and quality physician organizations, also known as concierge medicine, TAM serves a small patient population, with each patient having 24/7 full access to their own personal doctor.

Todays emergency state limits traditional general practitioners to telehealth calls for which patients may be billed out of pocket. In comparison, TAM patients can reach their physician via cell phone, text, email, video, and, when medically necessary, by house calls. Located throughout Philadelphias Western suburbs, South Jersey and Wilmington, Delaware, TAM doctors specialize in family, internal, geriatric and integrative medicine. They offer personalized, attentive care for seniors, individuals and families, potentially alleviating the need for emergency treatment at this crucial time.

"COVID-19 has exposed only a fraction of the shortsightedness and problems of our modern health care system," shared Richard Stamps, President and CEO, Total Access Medical. "The system is designed around illness, not health. We want people to know there is another option out there. Total Access Medical alleviates the stress and fear around this virus and offers expert physicians who partner with their patients in order to work towards a common goal of obtaining optimal health and wellness, at all times."

Patient care is the priority of TAM. Additional benefits of interest at this time include:

- TAM practices are approximately 20% the size of a conventional general practitioner, allowing physicians to genuinely know their patients, and have the time and resources to personally coordinate care as needed.- Patients do not pay a single dime for unlimited access to these benefits outside of their reasonable membership fee, which is more affordable than most gyms.- Members have access to a nutritionist, who during this pandemic can support patients in building an immune boosting diet to help protect themselves from the virus, in addition to providing general weight loss and nutrition information.- Patients receive a minimum of 30 minutes for each appointment and 90 minutes at a minimum for new patient visits and physicals, as time constraints of a traditional medical practice are non-existent.

About Total Access Medical:

Total Access Medical (TAM) is a quality and affordable direct primary care program comprised of a comprehensive suite of services designed to accommodate the needs of each individual patient. TAM offers six expert physicians in family, internal, geriatric and integrative medicine along with additional non-clinical services to further enhance the patient experience. Offices are available in Bala Cynwyd, Bryn Mawr, St. Davids, and West Chester, PA, along with Mt. Laurel, NJ and Wilmington, DE.

Richard Stamps, President and CEO, created Total Access Medical in 2002 due to personal frustrations with the current health system. TAMs direct primary care model includes an affordable, flat-rate annual fee with no copayments for unrestricted access to a concierge doctor of the patients choice.

Additional benefits of Total Access Medical include:

To learn more about Total Access Medical visit or call 800-318-6125. Specific features and benefits may vary by physician. A Total Access Medical Personal Care Representative may offer additional details on services.

For media interviews with local physicians or Total Access Medical executive, please call Leslie Padilla at 267-800-4316 or email

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LESLIE PADILLA, Principal LPPR, LLCP 267.800.4316E

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COVID-19: Tips for mindfulness and coping with anxiety – Greater Milwaukee Today

Amid ever-changing information around the COVID-19 pandemic, many people are experiencing heightened stress and anxiety.

Anxiety is not right, and it is not wrong. It is just part of the human experience, says Kristin Lothman, a mind-body counselor with Mayo Clinics Department of Integrative Medicine and Health. Healthy anxiety calls us into action to be safe, to take care of the people that we love and to arrive at the present moment experience with resilience.

There are many strategies to manage anxiety, Lothman says. I recommend developing a self-care practice. Elements of that could include journaling, exercise, yoga, meditation and prayer.

Another way to cope with anxiety is to practice mindfulness, Lothman says.

Mindfulness is about paying attention on purpose to the present moment. And I believe mindfulness is a powerful tool we can use right now.

Lothman adds that mindfulness is about focus and awareness. The best way I can connect is to not be distracted, to bepresent, to engage in eye contact, she says. To calm the body and mind, Lothman suggests a guided meditation a practice of relaxed concentration where you follow the instructions of a narrator related to breathing and imagery. Breathing exercises are also valuable, especially for younger children.

You might practice these three or four times a day. Maybe not the entire meditation but even if you can get in 10 breathes that may be enough to notice a shift in your inner experience, Lothman says.

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What to do if someone in your apartment building has tested positive for coronavirus – Business Insider – Business Insider

As the coronavirus pandemic continues to spread in dense urban cities in the US, some residents of multi-unit buildings will undoubtedly be faced with the reality of an infected neighbor.

But there's no reason for neighbors in an apartment or condo building to panic, according to infectious disease experts who spoke with Business Insider, as the risk of the virus passing through the building is low if proper practices such as self-quarantine and social distancing are followed.

"Theoretically if someone is infected we are pretty confident as long as the person stays in the room the risk [of transmission] should be low," said Dr. Thomas Russo, Chief of the Division of Infectious Disease at the University at Buffalo.

Experts say that the risk of widespread infection in a building is unlikely because the mode of transmission of the coronavirus is primarily respiratory, meaning it is spread directly through breathing in respiratory droplets expelled by sneezes or coughs, which requires close contact with an infected individual. Social distancing of at least six feet will minimize that risk.

And if you're worried about getting the virus through the air vents, "airborne transmission from person-to-person over long distances is unlikely," according to the CDC.

The virus particles, "are typically only suspended in air for short periods of time, though this virus has been detected suspended in air (what we call aerosols) for up to three hours," said Dr. Anthony Kaveh, a Stanford and Harvard trained physician anesthesiologist and integrative medicine specialist. "We do not suspect that this represents a major mode of contracting the disease," Kaveh said. One caveat is that if you're outside, the wind might help infectious aerosols travel longer distances than they otherwise might.

The secondary mode of spread is through touching surfaces that those droplets have landed on and then touching the face, eyes, or mouth.

To keep the risk as low as possible, experts say, it falls on both the residents of the building, building management and the infected person or people to follow the Center for Disease Control's guidelines as strictly as possible.

If you feel sick, "you need to go ahead and stay in the house you should not go out unless you have no other options," Russo said. "If you do you should wear a mask. Have other people shop and leave [groceries] outside your door. Put a mask on to go out to get your food."

For residents of a building with a confirmed case, the most important precaution to take is to practice good hand hygiene by restraining from touching your face and ensuring you wash your hands when entering your unit.

"If I were living in an apartment building I would limit my time outside my household or apartment," said Anthony Santella, a public health professor at Hofstra University.

"We can really only control things inside of where we live. Even if you have the best intentions and follow CDC guidelines you can't control the behaviors of other individuals."

Santella recommended avoiding getting into an elevator with other residents and wiping down anything that is exposed to other people that you might end up touching such as door handles, mailboxes, and elevator buttons.

"It may mean taking the stairs or waiting for an empty elevator," he said. "I would be very careful of what I touch. What we are learning about the virus is that it can live on different surfaces for different lengths of time. Whether it's plastic, wood, metal, etcetera, the virus will live for different times depending on the surface."

According to a study in The New England Journal of Medicine, the virus can remain infectious on cardboard for up to 24 hours, on plastic and steel for up to 72 hours, and on copper for up to four hours.

When regularly wiping down surfaces in the household do it first with cleaner and secondly with disinfectant, both experts advised. And if you have roommates, be extra cautious.

"If you were living in an apartment with three or four roommates and they are touching the microwave, and the kitchen counter, then you touch your eye, you eat a burrito, that's how the virus gets inside of us," Santella said.

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How cannabis and humans evolved together – Leafly

Janet BurnsMarch 30, 2020

Cannabis and humans co-evolved over thousands of years, each helping the other thrive and expand across the planet. (Jesse Milns/Leafly)

For humans,like most species, surviving life on Earth isnt exactly easy. But thankfully were not in it alone.

For tens of thousands of years, Homo sapiens has been developing mutually beneficial relationships with other species, from dogs and cats to bacteria and breadfruit. These interactions have allowed our different life forms to evolve and flourish together. These relationships are examples ofmutualistic coevolution, which happens when multiple species beneficially affect each others progress over time.

Theyre also a key part of what Dr. Sunil K. Aggarwal calls humankinds evolutionary garden. Aggarwal is a physician, medical geographer, and co-founder of the Advanced Integrative Medical Science (AIMS) Institute in Seattle. In 2013, he published one of the foundational articles on the subject, Tis in our nature: taking the human-cannabis relationship seriously in health science and public policy, in the medical journalFrontiers in Psychiatry.

The garden he describes is acollection of plants, fungi, and animal secretions that people have cultivated since prehistory, and carried around the world, because of their usefulness for human health and survival, whether as food, medicine, clothing, or other vital supplies.

Most are still embraced today, from honey and grains to caffeine and aspirin. In the past century, however, some cultures have decided its a good idea to cordon off certain areas of that garden, despite a long evolutionary historyand current scientific datasuggesting otherwise.

These blacklisted species include plants and fungi that humans have carefully administered for millennia to treat some of our worst sicknesses and pain, of both body and mind: distilled opium plants for physical agony, for example, or psilocybin tea for processing some of lifes most difficult moments.

Many are powerful, and can even be dangerous (in classic or modern forms) without supervision and guidance. Some have multiple uses, but never caught on in certain cultures.

According to Aggarwal, however, and to a growing number of experts on history and biology, one forbidden species stands out as our biggest loss, and for likely being the single most useful plant that humans have ever gotten to knowand which may even have helped us become more human.

That plant, of course, is cannabis.

Current research indicates that humans have been cultivating cannabis for tens of thousands of years, but aspects of our biology suggest that the relationship reaches back much further.

As a medical geographer, Aggarwal has studied the path of numerous natural medicines in different cultures and around the globe, based on anthropological and archaeological evidence.

Cannabis is one of the oldest medicines on record, he says. Its been evolving across the planet for tens of millions of years, stemming from its sturdy ancestors in Central Asia. In fact, early cannabis seems to trace back to when the worlds tallest mountain range, the Himalayas, were forming.

Sixty million years ago, those mountains were formed by the Indian subcontinent hitting the Asian plate, Aggarwal explained in a phone interview. All life there had to adapt or die.

It created a unique opportunity for this ancestral plant, which appeared 40 to 50 million years ago, to become very active in production, he said. There was less oxygen, and increased UV radiation, so the plant had to develop quite a bit of hardiness.

In the millions of years since, cannabis has shown a remarkable ability to survive in a wide variety of climates, from scrub-like Cannabis ruderalis to bush-like Cannabis indica and tall-growing Cannabis sativa and their hybrids, which produce most of our cannabis flower and low-THC hemp today.

Cannabis also appears to have been chemically compatible with the brains of animals, including humans, for much of that time.

In response to its new, harsher environs near the Himalayas, Aggarwal said, the plant seemingly began to produce a wide range of terpenes and cannabinoid chemicals, which the human bodywith its balance-keeping endocannabinoid system, which relies on cannabinoid neuroreceptors throughout the body, and can be found in all vertebrate speciesis especially suited to process.

The endocannabinoid system is key to our overall health and wellness because it has a crucial role in homeostasis, the regulation of our major biological functions. Our bodies are constantly working to maintain a narrow operative balance, and cannabinoid compounds can trigger the endocannabinoid system to regain this important equilibrium throughout the body as needed.

Despite their name, cannabinoid chemicals arent unique to cannabis. The compound type CBG, from which all phytocannabinoid compounds are derived, is found in many other plants, like echinacea, turmeric, and kava, to name a few.

But cannabis robustly produces tons of them, Aggarwal said. As a result, people living near the Tibetan Plateau domesticated the plant early on and found a great number of uses. That includes the neurological side, which is very interesting, as well as good old nutrition, and fibers for cordage.

It affects our neurological circuits and has a very important role in protecting the brain from injury, and promoting feelings of relaxation, Aggarwal added. Physical and psychological trauma can disturb the brain, and sub-optimize it. The endocannabinoid system, and phytocannabinoids if need be, can set the brain on the path toward regeneration.

In short, Aggarwal said, this cannabis ancestor happened to make these compounds that bind to receptors in the human system which tap into an even older evolutionarily evolved biological system, which goes back 600 million years: a magnitude older in terms of stages of the formation of life.

Specifically, those receptor typesknown as CB1 and CB2 todaytrace back to when multicellular organisms were becoming multicellular and were trying to figure out how to send communication and modulate action.

In biogenetic mapping, when you look at different species and map how old they are, you find cannabinoid receptors going back, and through today. In Homo sapiens, its a really integrated system for cell communication.

On the cellular level, cannabinoids are also particularly useful for their anti-inflammatory and antioxidant properties, throughout the body as well as the brain. These aspects help the body to maintain optimal performance across its systems from the intercellular level on up, like other natural supplements that ease the way for the body to do its job.

In terms of their antioxidant properties and neuroprotective properties, cannabinoids are certainly not the only game in town, Aggarwal said. But theyre pretty high up there.

Aside from archaeological and biological evidence, humankinds relationship with cannabis has been documented for thousands of years in printed language, and in oral histories that reach back even further.

As Aggarwal wrote in 2013, Cannabiss very name belies its longstanding relationship with humanity, as it was pragmatically given the species name Sativa in 1542 by German physician-botanist Leonhart Fuchs, meaning cultivated or useful in Latin.

Researcher Rob Clarke, whos written or co-authored numerous texts on cannabis history and biology, told Leafly that, simply put, cannabis seems to be one of the most useful plant that humans have ever come across. Plenty of plants are used for one purpose, and I can name a number of plants that are used for two purposes, he said. But I cant think of another one thats used for three.

For example, Palms provide us with food, and with fibers for clothing or shelter; bamboo is the same, he said. Other members of the garden provide us with both food and drugs, such as numerous fruits, roots, and grains that people have long eaten but also fermented into alcohol,like cannabis evolutionary cousin hops.

But cannabis has all three, Clarke said: Food, fiber, and drugs. Meaning that, from just one kind of crop, humans can get an important source of protein, fiber for building and crafting, and medical or cultural tools for our minds and bodies.

On a biological level, stimulating our endocannabinoid system is one part of the bodys toolkit for social navigation and balance. Psychological research has shown, in fact, that when you boost the bodys endocannabinoid system, people feel the emotional impacts of rejection less, Aggarwal said. Acetaminophen can do that, too. Its like a pinball game.

Martin Lee, co-founder and director of Project CBD and the author of several books on cannabis, explained in an interview with Leafly that plants, like humans, have ways of dealing with stressors, and expressing that stress physically. Cannabis plants do it through chemical signals, odors, things like that, said Lee. Plants under stressif theyre being eaten by insects or whateverhave evolved to communicate with their environment to deal with those stressors.

They might have a smell that attracts a predator of the thing attacking the plant, or that will keep potential predators away. And it so happens that these same smells, the same molecules that [cannabis] uses to deal with stress, are very helpful to the human brain in dealing with stress.

In fact, this part of the human-cannabis relationship may explain a lot about the plants history and status in the US, and in other Euro-colonized zones around the world, according to Aggarwal and his peers.

By the early 1600s, the British empire and others in Europe were all on board for hemp as a valuable industrial commodity. In the ensuing centuries, they and their colonies would increasingly embrace cannabis medicine, too (leading to Eli Lillys early 20th-century cannabis tonics, for example, and the U.S. governments late 20th-century patents on cannabis as an anti-oxidant and neuroprotectantbut hang onto that thought for now).

During the same timeframe, the European slave trade was booming, with hemp among the top crops that millions of trafficked and enslaved people of African, Central and South American, and North American Indigenous origin were being forced to grow. In the 1600s, Aggarwal said, cannabis as a cultural and spiritual drug probably first appeared in what is now the US among these enslaved populations.

By the 1920s, the socially and emotionally helpful plant had been included in any number of reputable Western pharmacopeia, and was arriving state-side in refrigerated bargeshence the name reefer, Aggarwal said, becoming an integral part of the fabric of the US jazz scene.By that time, however, most US states and municipalities had also chosen to outlaw the plant despite its medical history here. In 1930, the US deemed the plant federally illegal.

In decades since, however, its continued to offer social relief to many of our countrys most oppressed and weighed-upon populations, Aggarwal said. Other researchers have said it also provided some of our most exploited groups with a budding source of financial independence, which may tie directly to todays underground market.

It even seems possible that cannabis particularly helped kickstart our evolution toward being the big-brained, culture-prone critical thinkers we are today. This could have occurred for practical, nutritional, or psychoactive reasons, or (like the plant itself) as a mixture.

In terms of humans neurological development and nutrition, Lee explained, Agriculture is really a turning point as the beginning of hoarding and carbohydrate farming, which was different from earlier diets. He continued, Its possible that cannabis is the first agricultural plant, and its certainly one of the very, very early ones. And cannabis is unique because its so versatile.

Today, Lee noted, humans are finding all kinds of new ways to use it (whether in food, medicine, industrial or artisanal fabrics, hempcrete, fuel, or many other forms), as well as better ways to appreciate its psychoactive effects. But as obvious as its usefulness in human lives and history may be, theres one thing we may never know about cannabis: how the first humans got high.

We can only speculate how people first discovered cannabis psychoactive aspects, Lee reflected. Its hard to imagine it would have come through eating it but, for various reasons, you can imagine they inhaled smoke accidentally.

Janet Burns is a freelance writer based in Brooklyn who finds drugs, tech, labor, and culture extremely interesting, among other things. She also hosts the cannabis news and conversation podcast The Toke.

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Unlocking the Secrets of Brown Fat – Michigan Medicine

In recent years, brown fat has garnered attention as the so-called good fat that can protect against obesity and its associated health risks, like cardiovascular disease and diabetes. Two separate major studies, one led by Liangyou Rui, Ph.D. and one by Ling Qi, Ph.D., both with the department of molecular & integrative physiology, help explain brown fats properties.

Located in small pockets throughout the body, most mammals use brown fat (and its closely related cousin beige fat) to stay warm. In mice and humans, if you have more brown or beige fat, you are more protected from metabolic disease, says Rui, the Louis G. D'Alecy Collegiate Professor of physiology at U-M Medical School, whose lab studies the molecular and physiological mechanisms of obesity, diabetes and fatty liver disease. In a new study published in Nature Communications, Rui, first author Lin Jiang, Ph.D., and their colleagues reveal a pathway by which the hormone leptin contributes to weight loss.

Leptin regulates body weight by controlling appetite and energy expenditure, but exactly how has been a mystery. What is known, says Rui, is that leptin activates brown and beige fat. The new study elucidates a molecular accelerator of leptin action in the brain called Sh2b1. His team has found that Sh2b1 in the hypothalamus, an important brain region controlling body temperature and hunger among other functions, promotes the stimulation of the sympathetic nervous system. The sympathetic nervous system sends signals to brown and beige fat to activate it, thus maintaining body weight and metabolism.

The team demonstrated this proof-of-principle by creating two mouse models. Mice that lacked the Sh2b1 gene in the leptin receptor neurons had an incredibly reduced sympathetic drive to the brown and beige fat and reduced capability to promote energy expenditure, says Rui. This reduced the ability of brown fat to be metabolized into heat, lowering the mices core body temperature. Whats more, the mice also developed obesity, insulin resistance and a fatty liver. In contrast, mice with extra expression of Sh2b1 in their brains were protected from obesity.

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No one knew that Sh2b1 in the brain controls the sympathetic nervous system or was required for leptin to activate brown fat to increase energy expenditure, notes Rui. As for how this finding could be applied to humans, he says the hope is to eventually find a way to increase expression of Sh2b1 or its ability to enhance leptin signaling and fat burning.

Other U-M authors contributing to this paper include: Haoran Su, Xiaoyin Wu, Hong Shen, Min-Hyun Kim, Yuan Li, Martin G. Myers Jr, and Chung Owyang.

Brown fat gets its color from high amounts of iron-containing mitochondria, unlike the standard white fat linked to obesity. A team led by Qi, a professor of molecular & integrative physiology and internal medicine at U-M Medical School has been studying how mitochondria, the power plant of the cell, and another cellular structure called the endoplasmic reticulum (ER), which is involved in the production of proteins and lipids, interact inside brown fat cells.

In particular, theyve studied the role of a protein complex involved in a process called ER-associated protein degradation, or ERAD. Simply put, ERAD is the process of removing and destroying misfolded proteins, like taking out the trash out of the ER.

Everyone thought that ERAD was just part of the general cellular response when cells are undergoing ER stress, says Qi. Weve shown over the past six years that it plays a fundamental role in health and disease.

In a new study, published in Science, Qi along with first authors Zhangsen Zhou, Ph.D., Mauricio Torres, Ph.D., and their colleagues demonstrate how an ERAD protein complex affects the proper function of mitochondria.

Typically, the ER and mitochondria have ongoing interaction at touch points called mitochondria-associated membranes. These points of contact mark areas for mitochondria to divide for the production of new mitochondria and for the exchange of other molecules such as lipids and calcium. The ER forms tubules that surround the mitochondria to get them ready for division.

Using state of the art 3D imaging, the researchers discovered what happens to mitochondria in brown fat that are missing part of an ERAD protein complex, called Sel1L-Hrd1, when exposed to cold.

When you delete this complex in brown adipocytes, the mitochondria become elongated and enlarged, says Qi. The 3D image enabled them to view a previously unrecognized interaction between the mitochondria and the ER, with the mitochondria wrapping in a U-shape around the ER tubules.

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When the mice were placed in a cold environment, the ends of the outer membrane of the mitochondria folded back on itself, eventually fusing and completely enveloping the ER tubules. The result, says Qi, are abnormally large, misshapen, dysfunctional mitochondria.

We showed that these mitochondria dont function normally and the mice become cold sensitive, their body temperature dropping very quickly, says Qi. In other words, without this ERAD protein complex, the brown fat is not being used to generate heat. Under a microscope, this dysfunctional brown fat had larger droplets of lipids than brown fat from mice with the protein complex intact.

This is highly unexpected. The results here fundamentally change our understanding of ER-mitochondrial communication and further demonstrate the importance of an ER degradation complex in cell biology.

This paper also includes contributions from the following U-M authors: Christopher Halbrook, Franoise Van den Bergh, Rachel B. Reinert, Siwen Wang, Yingying Luo, Allen H. Hunter, Thomas H. Sanderson, Aaron Taylor, Costas A. Lyssiotis, Jun Wu and Daniel A. Beard.

Papers cited:

Leptin receptor-expressing neuron Sh2b1 supports sympathetic nervous system and protects against obesity and metabolic disease, Nature Communications, DOI: 10.1038/s41467-020-15328-3

Endoplasmic reticulumassociated degradation regulates mitochondrial dynamics in brown adipocytes, Science, DOI: 10.1126/science.aay2494

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Why you may want to try this popular diet during the Coronavirus pandemic – Ladders

Its a weird time in life. Just getting through the day without a major meltdown is probably your top priority right now and not whether you should go on a diet or not. However,Quarantine 15 is becoming a real thing as some people are finding it harder to work out (even though there are countless online resources) and stress eating becomes your default. So even though it seems daunting, now may be the time to consider intermittent fasting.

It goes back to that classic old advice of Feed a fever, starve a cold.Jaime Schehr N.D., R.D., an expert in integrative medicine and nutrition, told Mind Body Green of that instruction, While thats not scientific, its this idea that when were fighting a cold or a virus, decreasing our intake of foods and increasing our fluids actually works to support the immune system.

Fasting leads to lower levels of glucose [blood sugar]. In response, the body uses fat instead of glucose as a source of energy, after turning the fat into ketones, registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Womens Hospital, said.One study found that this diet mayreduce body weightby up to 8% and decrease body fat by up to 16% over 312 weeks.

Other benefits of intermittent fasting include less inflammation, lowered blood pressure and heart rate, reduced insulin resistance, lower bad LDL cholesterol levels, and higher good HDL cholesterol levels.

In one studyon fastings relationship to aging that used rodents, the rats that fasted every other day lived 83% longer than those that did not. Given the known benefits for metabolism and all sorts of health markers, it makes sense that intermittent fasting could help you live a longer and healthier life, adds nutrition and wellness reporterKris Gunnars, BSc.

There are different approaches to intermittent fasting such as the16:8 plan where you fast 16 hours in a row and then eat normally within an eight-hour period. Or the5:2 approach, in which you eat normally for five days in a row; then for two days in a row, you eat just 400 to 500 calories per day.

Intermittent fasting can also help you focus more as you have to pay a bit more attention to what you are eating instead of mindlessly stuffing your face.

However, do note that there is no research finding that intermittent fasting boosts your immune system short-term so it should not be labeled as a way to prevent Coronavirus but it could help you in the long run.

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