Doctor REVEALS How To REDUCE INFLAMMATION & Fight Viruses | Dr. William Li

Too many doctors aren't listening. What is the underlying cause? This is a new disease, so we have to like pay super attention.

Tell us in terms of your discovery of Long Hauler Syndrome, like who is the most at risk for it? How is it working? Is the virus still there? Is it just creating like a feed forward cycle of inflammation that gets stuck on, like, you know, like the gas pedal gets stuck to the floor with.

The inflammation that can't stop? What's actually going on? So here's what the three things that the three legs of the stool we found in Long Haulers. The microvascular damage from acute COVID seems to continue to be there. Small blood vessels damage endothelium, the lining of the blood vessels feeding 60,000 miles.

Of your circulation there. We find it in the lungs.

Is the virus still there though, or is it gone? So, this is the thing we don't yet know. When you swab these people who are suffering from long haulers, the nasal swab, the saliva test, the fecal test, PCR negative. They don't actually have the virus. So they are by the usual testing methods not infected. However, the bizarre thing is about 41% of people who have long haulers who get a vaccine, they report that some of their symptoms actually get better. So that's another twist. So how would that be? How could a vaccine would actually heal, you know, what's damaged? Vaccines are really kind of a shield in general. Yeah. Boost your immune system, prevent more of it. So, we're wondering whether or not, like in Lyme disease or syphilis or in shingles or herpes or whatever. Could there be hidden reservoirs of virus that are not detectable with the usual tests that are hanging out somewhere? Could it be in the crevices of our gums? Could they be in the testes? Can they be in all these little crypts of the intestines? We do know that some of the most important health defenses of our body, our microbiome, for example, are thrown out of whack when you actually have COVID. And so, you know, one of the things that we really need to start doing now is to try to figure out how do we fortify the body? And I think diet and lifestyle is one of them because, you know, biotech and pharmaceuticals, they'll come, but they take way too long. What can we do for people that are recovering? Now, let me give you a statistic that I think is really sobering. So, you know, about a little, just under 150 million people have gotten COVID. About three-ish million people have died. So if you were to divide the deaths over the denominator, it's not the most fatal disease that we've ever had. On the other hand, if anywhere from a third to 70% of people develop some manifestation of long haulers, let's be conservative and call it a third. You're talking about- 50 million. Almost 50 million people that actually are at risk for developing long haulers. that is a healthcare system crushing disease. If it actually, this would be a second pandemic to come out of the first. So one of the reasons that I'm so passionate about trying to establish what's going on, who's most vulnerable, what can we do both on sort of the medical industrial side, which is very important, but also I think on the diet and lifestyle side, because there's so much we can do to lower inflammation, get better circulation and help improve our nerve function. Those are things that we might be able to actually explore.

Yeah, I think that's really key. So one is sort of deepening our understanding of what's going on. Is there some active virus still there? Is it just residual effects? How do we begin to help the body reset and repair from long hauler syndrome? Is it treatable? I mean, I think these are all the questions that are coming up. And traditional medicine, you know, I believe has very little to offer in the face of something like long hauler. At Cleveland Clinic, we now have a recover clinic. which is a multidisciplinary team that's working on looking at the biology of this, looking at what kind of interventions we can use and using, again, lifestyle approaches, functional medicine approaches. That may be part of the answer for people. We're going to talk about something that is quite scary to me. COVID is scary enough, but what's really scary to me is the after effect of COVID that we're seeing in so many people. With SARS, the original coronavirus infection, there was a 40% chronic fatigue rate at three years in these patients. And that's terrifying to me because today in America, we have had over 30 million cases. We probably have about 500,000 something deaths, but probably a lot more who've been infected. And globally, the numbers are staggering in terms of how many people have actually been infected with COVID And so if one in three of these people might get something like chronic fatigue, that's just a massive burden on our system. And we're beginning to just understand how prevalent this is, how debilitating it is, how scary it is. And honestly, I'm not that I'm not scared of getting COVID. I'm scared of getting long hauler syndrome. So tell us what we've learned about why our bodies seem to be so vulnerable to this COVID-19 virus and why these vulnerabilities leave us exposed to getting this long hauler syndrome.

Yeah, well, Mark, you know, that is the pressing question I think we're going to be facing as a nation and as a healthcare system probably for the next decade. Because while I do think that the light is at the of the tunnel for the pandemic itself as more people are vaccinated, as the seasons change, and hopefully any mutations or variants will become less problematic for us. I mean, that's the thing crossing the fingers hope. The fact of the matter is that the tail and the long tail of this infection is something that is absolutely sobering to actually study.

And it's so prevalent. And I think, you know, most of us think, oh, well, you know, I'm young, I'm healthy, you know, I'm fit. It seems to be affecting mostly the elderly. the obese, the chronically ill. And those are the ones who are most risk for hospitalization and dying. And what's striking to me about long hauler is that even young, healthy people who get COVID and recover then go on to become long haulers, which is kind of terrifying to me because you think, oh, it's just the vulnerable who are really at risk of severe illness. But it's not. It turns out it's not. But, you know, what I think would be helpful people understand is that, is that the Blood vessels seem to be part of the key to this. You're an expert in blood vessels. You spent your whole life studying blood vessels. You created the Angiogenesis Foundation, this like 30 new medical discoveries and 70 different diseases. What can we learn from your work about how to approach the vascular damage from COVID and from long haul or COVID?

We've actually been actually capturing with imaging the damage of the blood vessels from COVID in lungs of people that have long haulers and they don't have any objective problems by x-ray or CT scan, but they still can't breathe. So, you know, you got to listen to the patient, right? Like, that's the first thing is to listen to what they're telling us in the medical community so we can pay attention. And too many doctors aren't listening. Yeah. And so this is a new disease. So we have to, like, pay super attention. Now, what we've actually done is take the CT scans. And I think that, you know, you, you and your listeners find this really cool. We're able to use artificial intelligence and machine learning to reconstruct the blood vessels from a CT scan. So we scan the scan to reconstruct the blood vessels and we can actually count the blood vessels, we can look at the density, we can compare to a thousand normal lungs to see where the problems are and how deficient. And I've had patients who actually are up to 80% deficient in their microcirculation of their lung nine months after recovering from COVID And to me, Wow. You talk about something scary. This patient looks completely fine except that she can't breathe very well. She's like in her mid-40s. And it doesn't happen all the time. It happens intermittently. And that's the scary part. So I think you're absolutely right that the usual medical system is at a huge disadvantage with new diseases because what do we do in the regular medical system? We go back into our toolkit, which is the medicine chest, and look for what prescriptions to write or what tests to do. This being new, if you don't understand the basic pathophysiology, what's going on underneath the body. So we know that blood vessels are missing. So one of the pieces of good news, sort of the bright light I can tell you about here, the cup half full, is that blood vessels we know can repair themselves. We can grow new blood vessels in order to restore our organs. So if you were to cut out part of your liver, it would grow right back and all the blood vessels would grow right back. We know when you cut yourself or have surgery, when that wound is there, it will grow blood vessels and it'll heal up the wound. It'll restore itself. And so angiogenesis itself is an absolutely critical thing. The issue though is with angiogenesis doesn't work very well when there's a ton of chronic inflammation. So now we need to help the blood vessels grow by lowering inflammation so that the healing can take place. And then we want to push the healing faster. So what do we actually do? We know that regular exercise and movement actually can actually help grow blood vessels. We know that stress, norepinephrine, catecholamines can actually slow down blood vessel growth. So we want to actually be a little more chill, more zen, and exercise and move more. We know that when you have a lot of catecholamines in your body, when you're not sleeping, that slows down healing as well. So again, back to lifestyle medicine, integrative medicine, a lot of these principles that you're not going to go to any of the famous name brand medical centers, they're not going to be writing a prescription for sleep. They're not going to be writing prescription for yoga. Okay? Now, I'm not saying that there aren't real medical interventions, but we don't have any treatments for this right now. So clinical trials are just getting started. The other thing I'll tell you is that our blood vessels partly restore themselves, grow back to repair using stem cells. These stem cells come from our bone marrow. Something scary, a relatively new finding is that COVID, SARS-CoV-2, the virus can get into the bone marrow and change the genetics of our bone marrow. That's truly stunning. And so the question is, do we need to do something to help restore bone marrow health? So we're not going to be giving ourselves EPO injections like in the hematology lab to pump out more blood cells. We're not going to be giving ourselves blood transfusions, but It does turn out that there are things that we eat that can stun our stem cells and our bone marrow, even without before COVID high saturated fat foods, ultra processed foods, processed meats, artificial sweeteners, all the things that you know, you've been talking about Mark for years, I've been talking about for years, there's another reason for us to actually cut down or cut out those things that would stun our stem cells in our bone marrow. So anything we can do to tip the balance in our body in favor of healing. is something we got to do.

So, what you're saying basically is despite the advances in modern medicine, the best ways to prevent and ultimately treat right now are focusing on the fundamentals of our lifestyle, a whole foods diet, getting rid of crap, exercise, meditation, sleep. These are the four pillars that help regulate your immune system, regulate inflammation, regulate all the biological functions, and We might minimize those, just think they're not as powerful as medication. But I think often it turns out that they're far more powerful when you apply them in the right dose, right? I mean, if you do one minute of walking, maybe it won't help, but if you do a half an hour or if you have, you know, if you're drinking 12 sodas a day and you have 10, probably not gonna, you know, improve things much. It's really about how you make those changes. One of the things I really want to get into with you is is what is coming around the corner around understanding the vascular biology of COVID-19 long hauler syndrome. Because it seems to me that that's the missing link that explains all the different symptoms people are having. It's almost like a blood vessel disease. You happen to be one of the world's experts in blood vessels and you sort of inadvertently got thrown into the mix of COVID which you weren't planning on, but it became evident that this is such a vascular problems. So you were sort of forced to almost dive into it and do this research. What are you and your colleagues looking at in terms of other besides the fundamental lifestyle things coming down the pike in terms of new treatments to repair their blood vessels and their health?

Yeah, so I'll break it down into different categories. The first thing we're trying to do is to get our arms around a better way to diagnose the problem. And so one thing that we're doing is actually taking CT scans from people who are continuing to have breathing problems in their chest, for example, and we're reconstructing the blood vessels so we can actually see the blood vessels like seeing is believing. That's important for the patient to understand what's going on. It's important for their doctors on the team to understand there is a pathophysiology that's not invisible.

It's just not in their head.

Not in their head. We can liberate it. This is not something that you give an anxiolytic to try to make it go away. This is real, number one. Number two is how do we actually what can we measure in the bloodstream that could give us a sense of the damage? And it turns out that, you know, the classic inflammatory markers like CRP don't seem to cut it. So what we're trying to do is go to a deeper level. Okay? And this is where vascular biology comes into play because over the last 20 years, we've been finding, you know, different particles and different growth factors that reflect blood vessel damage and reflect blood vessel healing. So is it an angiopoietin-2 peptide? Is it a soluble receptor for blood vessels are trying to fix themselves? In other words, can we detect with a blood test the supplies that your repair crew for your body's blood vessels are bringing to all these damaged organs to try to fix it? And we think the answer is yes. You know, the NIH actually convened a working group, a workshop to really discuss COVID damage. And it was not your, you know, just one division infectious diseases, but it was the neurologists, the pediatrics, the kidney people, the endocrinologists, all these different specialist came by and everybody said, look, you know, the current common currency that we need to talk about are blood vessels and inflammation, which go hand in hand. So we're trying to, what my group is trying to help discover new floating particles we can detect. Another interesting thing. So, a way to diagnose it, a way to diagnose. Diagnosis, yeah. And then also you want to be able to follow how it changes. Is it getting worse or getting better? And I think that's, so it's not just a diagnosis, it's also being able to monitor people to see how well they're actually doing. So imaging is one of the things. so let's talk about what's going on research of treating long hauler syndrome. Now, we don't fully understand it yet, so it's hard to come up with a definitive treatment or things that we're still figuring out. But as I mentioned, three legs of the stool, vascular damage, microvascular damage, tiniest blood vessels, number two, inflammation, chronic inflammation, maybe some autoimmunity. And the third thing is a neuropathy problem with nerves. So one of the things that we're actually trying to do is to figure out, is there a simple common pathway to repair blood vessels, repair nerves, and lower inflammation all at the same time, right? So sometimes, you know, being more complicated isn't the right solution. Sometimes being as simple as possible can actually at least give you a starting point. It's always easier to get more complicated. So one of the things we're looking at is nitric oxide, NO, which is a gas. It's a natural signaling molecule. It's the stuff that our cells make to repair themselves. themselves. It's what our blood vessels uses to dilate and to fix themselves. And it's what Viagra and Cialis actually caused the body to make, you know, with the obvious effects that they're intended to have.

So, you know, we have actually had Louis Ignaro on our podcast. So he was the guy who discovered NO or nitric oxide and has won the Nobel Prize for it.

I, I saw that Lou's an old friend of mine and an amazing guy. And, you know, what's amazing about Lou is that, you know, you know, in his As a senior statesman of research, he is the most friendly, accessible, passionate, brilliant, articulate guy that I know. And so I'm glad that he explained that. But I can tell you, when this all started, when we first made our discovery about the blood vessel damage, you know who's the first person I called? Lou Ignaro. Lou and I actually compared the notes on the gene expression, the pictures of the blood vessels, and we were thinking about this. I'm actually, I continue to move forward and am looking at working with some companies now that actually have nitric oxide stimulators. So let's look through this. There's some interesting efforts that can actually, you know, they have nitric oxide delivery systems that are in inhalers, not ready for prime time, in clinical trials for acute COVID. and the reason that that happened for acute COVID is because there was a really interesting successful clinical trial of inhaled nitric oxide in pregnant women who were on the ventilator or heading towards a ventilator and they found that you could actually rescue these women and their babies. And so definitely something that can help blood flow and repair, definitely life saving. And so one of the interesting- Should.

We all be taking Viagra for our blood vessels?

Well, so one end of the spectrum is actually this, the stuff in clinical trial, you know, but then, you know, so much of COVID has led us to talk about repurposing existing drugs, right? Because we can't wait 10 years, we got to sort of see what's available. And so, you know, like the hydroxychloroquine and ivermectins, and a lot of people have been coming up with different good ideas to sort of figure out, do they work or not? But it's really interesting because on the other end of the spectrum of not what is to be invented, but what's already around is Viagra, Cialis and all kinds of other things. Now, so that's an interesting clinical trial to be done. Vasodilates creates nitric oxide, affects repair, and nitric oxide causes stem cells to come out of our bone marrow to repair and regenerate our vessels as well. And it can actually help to repair neuropathy, which is another thing, and lower inflammation. So again, I'm super interested and I think there's huge amounts of promise that clinical trials actually need to be done for that. I think that, you know, there's also something to be said.

Should we be taking arginine that increases nitric oxide in the body?

Right. Well, so that's another interesting thing. There's dietary supplements that actually introduce arginine precursors and L-arginine, right? So you can actually have arginine and mix it in water. There's also medical foods like Juven that actually are approved for healing wounds. So I was having a, you know, I'm on the board of the American College of Wound Healing and Tissue Repair, and we've been talking about long COVID, and we are raising this specter that perhaps the long COVID is like the entire internal part of your body being turned into a chronic wound, stuck in the inflammatory phase, damaged blood vessels, not completing the cycle of actually healing itself up. So what do we do there? What kind of pages can we tear from the playbook for chronic wound healing from the biology to the clinical stuff to the treatments. So I think that, you know, it's really interesting to think about ArginAde, Juveness, wound healing substances, phosphodiesterase inhibitors like Viagra and Cialis. It is a whole spectrum. Now, I don't, I'm not, again, you know, we can't give medical advice on a podcast, but, you know, I think what we're sharing, I mean, Mark, you and I are both physicians that think deeply about mechanism of the disease. What we're actually sharing this conversation is really about how medical scientists and physicians that think about the science actually think about how to solve problems. So I don't think the answer is there yet, but I'm actually really encouraged that there are these tools that are out there that we might be able to do. I think one thing that, by the way, is really important to actually pursue is this clue why vaccination improves the symptoms in some people.

Yeah, explain that because I think it's sort of counterintuitive. and people who've already had COVID are getting vaccines because you can get COVID again. And some of those people who've had long hauler syndrome, who've had the virus are now getting better, which is kind of surprising. So explain us.

Totally surprising, totally counterintuitive. As I said, another wrinkle, another twist in the pandemic story that defies easy understanding. And this is where I think the medical community needs to really just admit our humility and to eat some humble pie, right? Like, it doesn't make sense. Why would that happen? And then you sort of have to put on your scientist hat to say, well, a vaccine shouldn't actually cause that kind of an improvement if there's damage in the body. A vaccine shouldn't cause the body to.

You know.

Shouldn'T be repairing the body, but the vaccine might be able to prompt immune system to fight residual virus. So is that part going on? The other thing, by the way, the vaccine might do is it might actually essentially control all delete and do a hard reboot of your whole immune system. Okay. And it could be that, you know, like the fire that COVID causes in many people, not all people, never quite goes out. So it's kind of like a forest fire that when it goes out, you still have this sort of burning brush underneath, even though it looks like it's mostly out, there's still flame there. And what you need to do to put that thing out, you know, is you need to actually just completely restart the hard drive, and then it'll actually go out and reset. And so, you know, I think you mentioned this earlier, another hypothesis, I mean, listen, for your viewers, this is just like medical research thinking in real time. You know, we don't have the answers, but we know at least we can actually try to ask questions.

It's fascinating to me that the virus may not be obviously detectable when you do the regular test, but maybe I'm wondering if you're doing biopsies of tissues if it show. And also I wonder if we're just stuck in a feed-forward cycle, because we see this a lot in functional medicine. People have chronic fatigue syndrome, have sort of weird, crazy symptoms for years and years, just don't get better. They've had Lyme disease, they've had Nephrosine B, they've had whatever an infection. and they just get stuck or they have, you know, gastritis and their gut is never the same. So there's this phenomenon in medicine where people get stuck in a feed forward cycle, which is very much like, you know, your record skipping. Many of you listening may not ever heard, ever had an album, but you and I are old enough to have record albums and they skip. I'm like Spotify and it just kind of keep going on and on and on and it gets stuck and it's almost like a biological groove that you can't get out of. And, and so a lot of functional medicine is about focusing on how to get people out of that feed forward cycle and reset their immune system and reset their biology. And we use a lot of different therapies, all of the basic foundational lifestyle things we talked about, you know, diet, exercise, sleep, and stress reduction, meditation. But there's also a host of other therapies we use to enhance the body's function, whether it's just adequate levels of vitamins and minerals and all their, their role or adequate levels of phytochemicals or herbs. And there's also a whole field of sort of regenerative medicine, which is looking at various therapies that are sort of biologic in a sense. They're biologic therapies that use substances that our bodies naturally have, but sort of give them in higher doses to enhance repair and healing such as stem cells. It's obvious why people know about exosomes, which are derived from stem cells and oxidative therapies, which, you know, we sometimes use, for example, in medicine, but like hyperbaric oxygen therapy, which can seem to be also helpful for some of these patients. I just had a patient who had long hauler syndrome, and she said the most profound thing she use hyperbaric oxygen therapy to recover, which increases wound healing, right? That's what you've studied. Well, yeah, yeah, yeah. Let me just finish. So there's a couple of other things as part of this spectrum of things that may push the body to reset like ozone therapy, which is being used in many other countries, but it's still sort of fringe here. But there's really good data on how this sort of pushes the body out of this cycle by suppressing the inflammation, activating your anti-inflammatory systems, antioxidant systems, repairing blood vessels. So there's a lot of therapies out there that are on the fringe that probably actually won't even be studied by traditional science, but I think have some among the most the most promising benefits. And I, and I, and I had the chance to treat a lot of long hauler patients. And I've seen that those people who do these other therapies often are the ones who recover the fastest.

No, it makes total sense. I mean, because this is, once you have system-wide damage or inflammation or imbalances, which is clearly what's actually happening with long haulers, I mean, and we can pinpoint it down to the cellular molecular level. the reality is that it's very unlikely that a single pill or a single prescription is going to actually do the job. And while integrative medicine is almost self-assigned to use tools that are on the fringe, listen, I think this pandemic pushed the entire human species to the edge. And so it's now time to actually look at those things that may not have been examined in the same way before and pull them up, pull them to the main stage and kind of say, is this something that can actually be helpful to us? And this is where it doesn't really matter what side of the equation you are or what, you know, what whose team you're on. It's basically like, let's look at stuff that can actually help. So what's interesting, I really like what you said about hyperbaric. So a lot of people in the wound healing world misunderstood what hyperbaric oxygen does, because the idea was to pump high oxygen pressure into a wound that's not healing because the wound needs more oxygen, because the blood vessels aren't quite as good. And indeed, you would actually see blood vessels growing pretty pro, pretty profoundly after doing these hyperbaric Dives, they call them dive Chambers. And it turns out there's a really interesting mechanism that is at play in hyperbaric therapy that might help explain your experience with Long Haulers. So when you're actually in the chamber, whether it's 40 minutes or an hour or whatever it is, you're training the body. You're resetting the barometer of the body to get used to high oxygen. And now the patient steps out of the hyperbaric tank or the chamber, and now suddenly their body that was used to very high oxygen suddenly is at sea level. Okay? Like, again, sort of like not low level oxygen again, okay? Or not actually having the same amount of hyperoxia, hyperoxygen. Now you actually trigger genes that are caused by hypoxia and not enough oxygen, and it turns on angiogenesis. And that's really what the blood vessels are growing in response to the change between chamber and not chamber. Chamber and not chamber. It's that delta between that pulls a trigger. The other thing that happens with hyperbaric is that one of the things when the trigger gets pulled is a domino effect and stem cells come out during in hyperbaric chambers. Yes. Regenerative. and that, to me, if it's happening in your wound, it could probably happen in your lungs and your heart and your brain. And that is really, really worthwhile studying. I know that there's some hyperbaric studies.

Again, looking at the microcirculation.

Yeah.

And that's called an oxidative therapy, which is sort of the opposite of what we typically think of. We'd want to do in medicines. We want to take antioxidants. Right. An oxidative stress is a bad thing, but it's not necessarily. It's. It's just part of our normal regulatory system. So when you have too much, it's bad. When you not enough, it's also bad. And I think that the effects of hyperbaric or ozone, these are what we call oxidative therapies, using oxygen, which is in a sense potentially harmful to the body, pushing it to respond by giving it this little insult, and then the body responds by hitting the repair setting. Your body has its own innate repair systems, and if you know how to activate those systems, then we can begin the healing process. And I think that's what's happening with Long Hauler syndrome. These people are getting stuck in a rut, a biological rut of inflammation. And there, there needs to be things that push them off of that. And you can't just take, you know, ibuprofen or steroids or any of that. You've got to figure out how to get the, because the body is way smarter and more powerful than any medication. And if we can activate those endogenous or internal innate healing mechanisms, I think we're going to see a lot of benefit. And that's, that's where I get the most benefit for my patients with chronic fatigue or Lyme or other chronic illnesses that are resistant to traditional treatments?

Yeah, no doubt. And, you know, and I think that this is where we need to look not at the solution as single solutions, but we need to look at the body as in need of multiple solutions and allow its own reset processes to be able to heal. So it's sort of can let the body complete its cycle of healing. because the body wants to heal itself. I mean, we've got, we're hardwired with health defense systems. I mean, our circulation is designed to operate at its optimal, and if you don't have enough, it'll grow more. If you have too many, it'll actually prune it back. And same thing as a regeneration. I mean, you know, like our organs are continuously regenerating. We're regenerating from the inside out invisibly and silently. And so when we actually need more repair, we need to be able to kick out some more stem cells and a great And now, an example I give you sort of clinically is in the burn clinic. So people who suffer, you know, bad body burns, you know, like thermal injury, whether it's a kitchen fire or they're an industrial fire when they've got bad body burns, that is like this prompt that we need to super repair ourselves, super regenerate. And that's when the stem cells come flying out. You can measure this in the bloodstream. And so, you know, another thing that could be done is actually to measure stem cells in the bloodstream for long haulers at diagnosis and then follow them over time to see if they've got, if they to push more stem cells out because we can actually measure those now.

So in the spectrum of what we're learning around COVID-19 and long-hauler syndrome, are you hopeful that we're going to be able to take care of this? Because to me, the prospect of 50 million people globally with long-hauler chronic fatigue syndrome, it just seems like a healthcare catastrophe. And in America, you're talking about, let's say 30 million people have had COVID, it's probably twice that easily because those are the ones who've been tested positive and maybe three times that, so maybe it's 100 million. that means, you know, 30 million people in America were walking around with some type of debilitating symptoms. And I don't know how prevalent it is. It depends perhaps on your infection or your hospitalizations or not. I saw one review that looked at cases out of the, you know, the hospital where people had been in the hospital with COVID-19 at 60 days, 87% had severe symptoms. That's almost 90% of people at two months were still sick. Now, maybe it's less if you're not in the hospital, but what is your.

Thinking about Well, you know, I mean, I think that there's been two recent studies that actually paint an even more dire picture. There was a study published in Nature looking from the Veterans Administration looking at 70,000 patients. I don't know if you saw this study, but basically people had recovered from COVID they had a 59% increase in mortality six months or later afterwards. And so this is, you know, this is not just something you put up with and get by with, but this actually can trigger even greater illnesses. And by the way, don't forget about all these other non-communicable diseases like diabetes and obesity and cardiovascular disease that we were struggling with before the pandemic. This is now a thick layer on top of that that might actually make the other ones a lot worse. And so I think that we're looking at a new human disease that we have the science, which is what makes me optimistic. We have the ability to think and peer through the veil of this condition to try to figure out what's going on. And I, what I'm really optimistic about. Well, let me first, before I say that, let me say what I'm not optimistic about. I'm not optimistic that the pharmaceutical industry is going to come up with that race to find that single targeted therapy that's going to cure long haulers. That I don't think is going to and I've got a lot of experience over 25 years working with biotech. I just don't think that model is going to succeed. I do think that they will contribute something modestly, and it won't work for everybody. But I do think that there is a bright bulb that has now been turned to white-hot, sort of white-hot heat to really be able to look more at a systems biology approach, a whole-person approach. The very things that you talked about, Mark, and you have been talking about, which, you know, if anybody has had any doubt that the body needs to heal itself, that we need to actually give the body a chance to heal itself, we need to actually prompt the body and give it every shot to be able to actually affect and complete the cycle of healing. And those things are usually not found in a prescription pad. Those things are usually not found in a medical clinic. Those things, you know, they exist in people's own homes. So now we actually have to stitch together this continuum between what happens in the doctor's office or, you know, the Cleveland Clinic or another great medical center with what actually happens at home. And so now this is not alternative. This is mainstream. And what I would tell you is that people who are only throwing drugs at patients with long haulers, they're the ones that's going to be practicing alternative medicine.

Well, that's a very interesting perspective. I'm not sure how that would go over in major academic centers, but I tend to agree with you. And I think that, you know, it's forcing us to rethink medicine because what we see with COVID-19 is it's not a respiratory disease, it's a systemic disease. And your work around the effect of COVID on blood vessels helps explain why. But by working in our silos, we're not going to be able to figure this out. And I think that, you know, in a sense, you know, like autoimmune disease, you know, we can give these powerful drugs to suppress the inflammation. But as soon as you stop those drugs, the disease is still there. So the question is, how do you organize a system of thinking to treat the whole system to create health and activate, as I said, these bodies, the body's own internal intelligence for healing, which is profound. I mean, when you begin to understand, like you said, you're just, just sitting like, you cut yourself and all of a sudden your blood vessels start growing. I mean, I still, like, I get a boo-boo and I'm like, wow, that's amazing. Like, that just, like, I burnt myself here in the stove. And I'm like, wow, look at that. It's like, perfect. And it's like, how does it do that? You know? And I think, I think that's not just happening on the outside. It's happening on the inside. so, and we understand a lot and a lot from your work about how do we enhance the, the health and the function of our internal systems and internal blood vessels. And your book, eat to be disease is such a great example of how we can use, for example, foods as medicine to, to start to repair and regulate these systems. And the way food and lifestyle works is not by a single pathway. It's by working on your whole system. And I think that's what's so different.

Well, you know, it's interesting that you bring this up because while we were all locked down, you know, with all this downtime to try to think through what is it that we can do, I was, you know, as we've been talking about, I was sort of busy trying to do the research and trying to figure out what was going on. But along the way, one of the things that I realized is that, you know, this situation of our lives being compromised by the pandemic, is really just a super concentrated example of how in before the pandemic, our lives are also being compromised by all these other things that actually hamper our own ability to be as healthy as possible. So, you know, one of the things that I started doing was to say, you know, we can't just wait for this kind of stuff to turn into a medical book to educate a medical doctor. We need to get the word out to people right away. So one thing I did do is I I created an online course. I kind of figured out how do we get information to people right away? How can we make it immediate? And so that's one of the things that I think is really important is that as more and more people start to spend time online learning, keeping up and researching, there's just a completely new way of actually communicating information to people as well. And that's basically what I do with my online course. so great.

I mean, that's great. You're empowering people with the tools they need to really take this on themselves.

Let me tell you sort of how I got into this. I'm an internal medicine doc. I'm a vascular biologist. You know, I, you know, you mentioned all the things I studied, like cancer and diabetes and vision loss and cardiovascular disease. The last thing on, on Earth I thought I would ever study is infectious disease. It was, you know, something that I had to deal with in a clinical career, but not something that I would actually thought that I would actually be kind of on the ship's prow of. But one of the things that happened in March 2020 when we were all, when everybody was locking down, this became like a joined human experience. There was this new disease that came upon us. And as a physician, I mean, you probably have a similar situation. You know, what was really stark and puzzling was why the people in the emergency rooms in the ICU are really flailing. I mean, here we are, a very modern medical system, and, you know, we were not able to get our arms around the people that were coming in. with low oxygen saturations, blood clots, and all these other kinds of problems that.

We.

You know, in a past era, you could explain, but in today's modern world, you would think that we would actually be more on top of this. And so for me, I sat and literally stared out the window from my bedroom wondering what distinguished ourselves from people who were dealing with the plague in the Middle Ages, you know, where they actually ran indoors in their stone homes waiting for the village crier to say it was safe to go back out into the town square again. And indeed, that's kind of what we're still doing, waiting for the CDC and other authorities to say, okay, go out and do your thing back to normal. And the thing that was really to me, the pressing mission I felt was as a scientist, I had an opportunity to try to throw my weight and contribute to solving this mystery of what this virus was actually doing to the body. And what I'll do is I'll I'll actually give you a spoiler alert right now for your listeners and viewers, which is this virus, the SARS-CoV-2 virus that causes COVID-19 has given us an unexpected twist at almost every turn of this pandemic. Just when we thought we knew something, it would throw another curveball at us. So first of all, respiratory virus was causing blood clots, strokes, problems with the heart, kidney failure, not what you would normally expect, right?

Intestinal problems too, right?

Intestinal problems, COVID toe, just the most puzzling things. And the things that we would normally do in the ICU, I used to run an ICU, okay? We would never think about flipping somebody on their stomach in an ICU. I mean, that's like turning a turkey in the oven. We would never do that. We'd have everybody flat on their backs. And so the rules were changing right before our eyes. and so I realized that one of the things that I could contribute, you know, that I could make at least a modest contribution to is trying to figure out what was actually happening, what was happening in the body that this virus was causing. So I actually got autopsy tissue from people who had died of COVID and I organized an international team from Belgium, Switzerland, Germany, and the US. And we dove into the tissue like a pathologist who went from lung, heart, brain, I mean, the whole body. And what we found was absolutely amazing and sobering. We found that this respiratory virus was infecting your lungs, but it was also infecting the blood vessels. It was a vascular infection. And we actually saw, you know, we're the first pictures of the coronavirus getting inside the endothelial cells, the endothelial cells of vessels. And we all know from cardiovascular disease and, you know, and heart health how important these vascular endothelial cells are. We don't want them to clot when they have they have to actually go very smoothly.

That's the lining of the blood vessels. Those are what we call endothelial cells. So all the lining, you've got 60,000 miles of blood vessels and the lining of that, the endothelium is so important. There's so many functions, not just like a little skin, it's actually very active.

And you're saying the virus gets into those cells and causes havoc throughout the body. Right into the cells and it changes the performance of the cells and these cells are supposed to, they're like a single layer inside a blood vessel and they make the inside of our blood vessels like an ice skating rink. so, you know, like, after a Zamboni cleans an ice skating rink, you can throw a sweater on it and the sort of go all the way across the rink after a hockey game. Okay. Uh, you know, that the ice is all roughed up. If you try to throw even a hockey puck on it, it'll stay there, right? Like, it's really hard to skate on it. And that's what we were seeing. This coronavirus was actually scuffing up that rink inside our blood vessels by messing up that single lining. Now, that endothelial damage, which was called endothelialitis. just like any other kind of tissue that winds up getting inflamed and damaged, wound up becoming the lead article of a New England Journal of Medicine research paper we wrote that really opened the door and changed the way that we were thinking about COVID because now it's not just a respiratory disease, it's a vascular disease. And because every organ is connected to our blood vessels to get oxygen and nutrients, now we began to understand how the organs were damaged. So this is acute COVID. And just when we thought that we kind of understood the, you know, a little bit more about acute COVID and antibodies are coming up and vaccines were being developed, suddenly the people who bounced back from COVID some were in the hospital, some were not, three, six, nine months later, they were crashing with long haulers, which was this bizarre constellation of more than a hundred different symptoms ranging from brain fog, chronic fatigue, ringing in the ears, racing heart, extreme muscle weakness, you name it, GI pain, vomiting or diarrhea or constipation. That is not explained. And patients were actually self-organizing to share their experiences. So they called themselves long haulers, like truckers that were driving across a country. And doctors didn't understand what was going on. So then we had to go figure out what was happening in long haulers.

William, you're deep into this field and understanding COVID. Recently, J&J's vaccine caused a set of complications, which is right up your alleyway, which has to do with unexpected blood clots, which is a blood vessel problem. Can you talk about why that's different with, for example, the J&J or AstraZeneca vaccines, which are viral vector vaccines versus the mRNA vaccines? In general, what's your perspective on vaccines? Are they the panacea? Are they just one tool? Are they going to save us or not? and let's sort of go into a little we have a little few minutes left. So I really want to sort of.

Get your perspective on vaccines. Yeah. Well, first of all, I mean, you know, I believe in vaccines. I was vaccinated for smallpox and measles and, you know, hepatitis to be a doctor and, you know, and a bunch of other things as well, which I haven't suffered those diseases. So I'm a big believer in vaccines and I've gotten my complete set of the first set of for COVID vaccine as well. I got an mRNA vaccine with Moderna. And I'm really proud of it because I think it's really quite a miracle that within a year we were able to go from, you know, sequencing the virus's genome to figuring out what the parts that we can develop a vaccine against and actually doing it and making it available. So there's no question in my mind that a vaccine is an important step to moving to the end of this pandemic to get to the light at the end of the tunnel. But it is definitely not the only one because, you know, I mean, we know that there's vaccines to flus and things like that, and it's not completely curative. It's still around. I think that that COVID is going to be kind of endemic. It's going to be a little bit of it around all the time, and we're just kind of adapt to it. But the vaccines are really, really important. I think the politicization of the pandemic and the politicization of the vaccines didn't help our understanding, but it really is quite a miracle that we actually pulled off these whole series of vaccines so quickly. Let's talk about Jane J and AstraZeneca for a second because, you know, honestly, another twist, the surprise that I had was that the simple vaccines based on old school delivery, which is an adenoviral vector, that that's basically how most flu vaccines are designed, would actually cause the biggest problem, which are these blood clots that scared a lot of people. Now, in truth, Mark, is that so few people develop this complication compared to being dead from COVID that in fact it's a mini- Out of 7 million.

There were six people who got the vaccine.

Exactly. Exactly. And the fact of the matter is that the consequences of COVID and long COVID, which we've talked about, are so much greater. But we are in a world where we have choices of different vaccines now. And so that's why this matters to be able to understand what's actually going on. So here's my best guess from research on what we think is going on with these blood clots with the vaccine. something about that spike protein that the vaccine is developed to challenge the immune system on. So, you know, the coronavirus is like a little ball, it's got these little spikes like a warhead on it, and these spikes stick into the receptor, the ACE2 receptor in our cell, and if we can actually get the spike, it's gonna like a sear chain, and we can get the immune system to target the spike, we can actually knock out the infection. So that's basically how these vaccines work, but you know, something about this spike, seems to infect blood vessels and screw up those blood vessels and cause that blood clotting that I showed you, you know, we talked about earlier. And so that, you know, like that I've been, I've been looking at. And so I think there is something unique about the armor of the spike protein of this vaccine that if you actually trigger the body too aggressively, it'll actually potentially cause some of those vaccines, sorry, the virus side effects. So here's the thing. the mRNA vaccine, which is the Pfizer Moderna, once you inject it, pretty much the mRNA is gone within 24 hours. Once you inject it, it pretty much gets destroyed afterwards. It's already triggered the effect that needs to trigger. The adeno-viral, the other vaccines stick around for days. One of the thinkings is that perhaps by having that spike protein signature stick around for days, it's just pissing off the immune system enough that in some people, we're getting this overage of a reaction. So, you know, there's this sort of a sign of, sort of like it's mimicked some of what COVID is actually doing. Now, obviously it's not happening to a lot of people. I tell people, get a vaccine, get the first vaccine you can get. Whatever it is, don't be too precious about it because we're going to be winding up to getting boosters. If you get a J&J now, you're going to switch over to a different one later. If you get a Pfizer now, you might go get a single shot later on with another one. So not to worry. But the key is if you want to step over the line to be protected, to be able to be maskless, to be able to not hurt yourself or other people who haven't been able to get the vaccine yet, just get the vaccine. It's a simple thing. I always tell people I timed it 90 seconds sitting in a chair. It felt like a mosquito bite or less. And, you know, and then I went on and literally I felt emotionally like I stepped over a line. The first shot I got, the second shot, But it was like I could breathe again in an odd sort of way. I realized that I kind of felt like I had a future to actually look forward to.

But let me challenge you on that. Is that really true? Because we're seeing that the vaccine is not 100% effective. We're seeing that you can still get COVID even if you've had the vaccine. We think you might be still able to transmit it even if you've been vaccinated, if you get it, and it can be transmitted asymptomatically. And we've seen all the variants against which it may not work as well. And so kind of just about the time we get re-vaccinated, now there's a whole slew of new variants from Brazil and from South Africa, you know, UK. And all of a sudden, like maybe the vaccine's not gonna be as effective against those. And we have to come up with new vaccines, booster shots, as you said. I mean, this just seems like a never ending story. And I worry about, you know, people are getting a false sense of security from being vaccinated and going out and like partying. And I think that could be a mistake that could lead to increased cases and increased deaths.

Absolutely, absolutely. So let's pull back for a second and say all the vaccines like the flu vaccine, you get it every year, supposed to get it every year, and it's not 100% effective, and you can still get the flu even when you get the flu vaccine because it could be a variant of the flu that takes you down, but you're not going to get as sick. You're not going to get so sick you might die. Now even some people who get flu vaccines still die from the flu. And so I think what we're aiming to do is to kind of turn this COVID-19 pandemic into something that's much more manageable. I will tell you what the data has shown so far, and we've seen this in Israel, which has done the best job hands down worldwide in getting everybody, as many people as they can vaccinated so far, is that people tend not to die. It really lowers, you can still get it. You might even get sick, but you're not going to get sick enough where you're paralyzed that you might go into a ventilator and die. that's a big deal to me. The unknown question, Mark, is whether or not if you get the vaccine and you get infected, you still develop long haulers. We think that having a lower number of virus particles in your body might be helpful. And yeah, you can still spread it just like you can spread the flu. If you get a flu shot, you can still spread it to somebody else as well. I think that the other underlying message though that you're trying to communicate that I so so important, so important is that getting the vaccine is only one part of it. Getting precautions and thinking not only about yourself, but other people and society at large is absolutely critical. The vaccine does not give us permission to go out to party, to go out like willy-nilly, to start coughing and breathing and going to have concerts again. You know, like nothing has changed that dramatically with the vaccines that we can suddenly unleash society. and I, you know, I was at a TED Conversations live session listening to a conversation with a consultant, a business consultant, but who's really a brilliant guy named Simon Sinek talk about being asked, so now that we see the light at the end of the tunnel, you know, what are we going to tell people who want to get about going back to normal? What advice can we give people about getting back to normal? And the answer was really brilliant. which is that's the wrong question because we are not going back to normal. After World War II, we didn't say, hey, let's go back to 1939. How do we do that? And after the 1918 flu, we didn't say, how do we actually go back to 1914? We said, how do we get into the roaring 20s? And so the question is, how do we move forward? How do we actually, you know, we're, we, humans are really smart. Americans are really, real ingenuity, you know, like in the country we live in, but also worldwide, I think that, you know, we live in a global community. and we have to not forget that even though people are now starting to try to re-acclimate back to going to restaurants and gathering again, there are parts of the world that are suffering dramatically. I mean, Latin America, Brazil, India, these are disasters, human disasters that are happening. And it's happening there. It's so easy that that could actually come over to hit us as well. So I think we are one world, one species, you know, one community and we really, when we think about our health, it's not a selfish thing. I mean, I think that we are, we also have the sort of one health concept as well when it comes to public health. So we have a responsibility to make sure not just ourselves and our families, but the rest of the world is also protected.

So take us, take us down the road two, three years. Where are we going to be? And are we hopeful or are we still going to be in this cycle?

No, I think I'm actually quite hopeful. I mean, if you, if you look at the Institute for Health Metrics and Evaluation, their forecast is that COVID is going to be endemic, which means that it's just going to be around. We're going to accept it. And it's going to flare in certain points, like in the fall and winter. And then when it gets warmer with higher temperatures and humidity, it'll actually go down. So it'll become a seasonal kind of infection. Hopefully, with more variants, what we want it to do, we want it to mutate like crazy until it mutates itself out of disease remotE. Okay. That's what we hope. In fact, you know, people like, well, we don't want more variants.

I would say just the opposite.

We want this thing to move. We want the right very heck out of itself. We want the right variance until it actually checks itself out. But in the meantime, I mean, I think that we. We all have shell shock. I mean, this is post-traumatic stress disorder for humans. Yeah, like our. Our. The entire civilization. This is the cough that brought in civilization to its knees, and now we are kind of getting back on our feet. I'm optimistic. you know, that we are going to be able to find a way to manage control this thing, but we are not out of the woods at this point yet. So people need to pony up, get vaccinated, continue to be aware of precautions, listen to the science, and listen to the people who are talking about policies, good policies based on science. And then let's figure out how we're going to move to 2022, 2023, 2024. So when you're asking me, what do I think is going to happen in the next two or three years? I think that this is going to be in our background. I think vaccination is just going to happen. I hope that as many people as we can get to get behind it will get vaccinated. I think that once you find cooler and better ways to live, to be honest with you, maybe we'll be cleaner. Maybe we'll actually have less flu. And I also think that we'll- I.

Bet the number of colds and flu has gone way down because everybody's hiding in their houses.

Yeah, exactly. And I think that we're going to have a lot more respect for the power of the body to heal itself. And that's the most optimistic thing I think for folks, you know, that have been in business, you and I have. I mean, we've been, it feels like, you know, sometimes that we've been like shouting against the, you know, like a hurricane on the outside. But I think people are starting to listen because, you know, there wasn't an easy solution you could pull off the pharmacy shelf. Now we're actually paying attention to the body and the body tells us it can heal itself. itself.

That's a great, hopeful message. I think that's whatever we should focus on is the fact that the body's own intelligence can repair given the right conditions. And it's the fundamentals of functional medicine. It's, you know, sort of innovative therapies that you're developing. It's things like the sort of regenerative or oxyotherapies. It might be helpful. We're still discovering it all, but I, I have seen many patients with long hauler syndrome, and I have seen them get better by using a very strategic approach. Hey, YouTube, if you like this video, you're gonna love the next This one. I really would love you to sort of summarize what have you learned in the last two years about how to deal with post-COVID and COVID itself with a functional medicine approach.

From the dietary perspective, from a preventive perspective, you can do this. A high polyphenol, high fiber diet has the best impact on the gut microbiome and general body inflammation. to prepare you for encountering this virus and to help you recover from it. Then there are a number of supplements that are really important. And the supplements that I focus on are those that enhance your body's ability to generate ACE2, the vital enzyme that is destroyed by this infection. And number one is vitamin D. Sometimes high doses are needed. number two are actually supplements of polyphenols and the two that have been the most studied and that are really mainstays in my treatment are curcumin, which is found in the spice turmeric, and is probably the most studied anti-inflammatory natural product that there is. And resveratrol, which is found in a number of vegetables. It's best known as is being found in red wine or red grapes and has been studied for its anti-aging and anti-inflammatory effects.

So, it's a combination of an Indian and an Italian diet, basically.

Yeah, right.

Curries and red wine.

Yes.

And.

So vitamin D, curcumin, and resveratrol are or stand, their foundation, foundation, foundation, the approach that I take.

Now, and that is pre, during and post.

Yeah, at all stages of this. In fact, curcumin has been studied, there are two studies, one from Iran and one from India, where people who are hospitalized with COVID-19 were given curcumin and it had a major impact on how they did in the hospital. I mean, it rivaled any study of any other treatment in terms of its impact on mortality or the need for mechanical curcumin.

Curcumin. Curcumin. And what were the doses?

Oh, you know, it depends on the form, roughly the equivalent of about a thousand milligrams a day. With a highly absorbed nano curcumin, they got away with less, but I aim for a thousand milligrams a day. and you can go higher. Another polyphenol that may have positive effects, but there's a different mechanism involved, is quercetin. I use that in the early stages for prevention. It's been shown to be effective there. Again, at a dose is roughly 1,000 milligrams a day.

Now, quercetin has been shown to be helpful in preventing the development of COVID in people who are exposed to the virus. That's probably through a separate mechanism where it blocks the ability of the virus to attach to your cells. Beyond that, quercetin has major anti-inflammatory effects and also can inhibit blood clotting and blood clots are one of the complications of COVID-19. So that group of polyphenols, apples, I found very helpful at all stages of this syndrome.

So eat curry, drink red wine and have like a bunch of orange peels and onions.

Onions and apples.

Right.

And, I mean, the whole, the dietary pattern, I think is important, especially from the preventive perspective.

Yeah.

The next thing is is there are certain probiotics that may be helpful in better balancing gut bacteria. When someone has had COVID-19, there is a probiotic that's not well known, actually was developed in Russia and the Ukraine about 40 or 50 years ago that I found really useful, especially for those with gastrointestinal symptoms. which is a lot of people with long COVID. And it's available over the internet under the name Tundrix, T-U-N-D-R-E-X. It actually is a soil-derived organism that secretes alpha-interferon. This virus is very sensitive to the impact of alpha-interferon, which really kills it. And one of the One of the things that the virus does to enable itself to establish infection is to find ways to turn off your alpha interferon response.

So, explain what alpha interferon is for those who don't know.

Right.

Alpha interferon is a protein. It's a cytokine produced by cells of your immune system. When you're exposed to a virus, part of the early antiviral response is the production of alpha interferon. In fact, people who produce alpha interferon in their nose are much less susceptible to getting sick with COVID-19. What this virus does is it finds ways to turn off your ability to produce alpha interferon. Ah, and that is one of the reasons it can establish itself so effectively. And the function that I use Tundrix for is it secretes its own alpha interferon. And so my goal with that is to have it stimulate the immune response in your gut and eliminate any traces of the virus. that happen to be in the GI tract.

This is a Russian probiotic. Can you get it in America?

Yes. It's available. It's been available for several months now, maybe a year, through a website, tundrix.tundrex.co. Not.com. I've been working with it for the past few years.

We will put that on the show notes for everybody listening, so don't worry.

Okay. Yeah, I've been using it mostly to help people recover from parasitic infection.

So, it's a soil microorganism from Siberian soil.

Yeah.

Back by decades of research and is now available here, which is amazing.

Yeah, I find that to be very helpful in recovery from the GI symptoms of COVID-19. And, I will probably use it more widely. me because I want to deal with this potential of viral persistence in the GI tract.

And, it's called Bacillus subtilis, right? That's the name of the bacteria.

Yeah, a particular strain of Bacillus subtilis. I think this is incredible.

So, we've got an anti-inflammatory diet with polyphenols and fiber. We have curcumin, resveratrol, vitamin D, Quercetin and Bacillus subtilis. Keep going.

And once you don't use the tundrcks indefinitely, it's a fairly short course, maybe 10 days or so.

Oh, wow.

Other probiotics that help to restore the Polish probiotic, fecula bacteria, and those are commercially available. There's a strain of bifidobacteria called BB-536. There's a different soil-based organism called Bacillus coagulans. And I talk about these on my website in a document called the Gut Microbiome and COVID-19.

And so we're going to link to that in the show notes, the Gut Microbiome and COVID-19 from Dr. Leo Galland's website, But I just want you to just keep going, 'cause it's a lot.

Sure.

These have been shown in controlled clinical studies to be anti-inflammatory and encourage the growth of F. Prausnitzii. Then in looking at, then we need to look at some other manifestations because the complexity of this infection doesn't stop with what it does to ACE2 and how destroying ACE2 creates blood clots, circulatory disturbances, changes in neurologic function. I mean, ACE2, when you look at everything that ACE2 does in the body, it's clear that 90% of what you're seeing in COVID-19 or in long COVID matches up with ACE2 deficiency. One of the effects of ACE2 deficiency is that the mitochondria take a hit. So mitochondria are these microscopic powerhouses that generate like 87% of the ATP that your body needs for energy.

And.

The mitochondria are damaged, especially those lining the blood vessels, are damaged by COVID-19. and so part of my protocol, especially if there is fatigue or heart problems, is mitochondrial repair. Let's get them up and running again. And merely restoring ACE2 may not be enough to do that.

How do you do that?

Well, the single supplement that's been the most studied in mitochondrial functional function is coenzyme Q10. And they're the doses that are needed are somewhere between 200 to 400 milligrams a day. It depends on the form of coenzyme Q10, but low doses won't work. You need a high dose. And CoQ10 is very safe. I have not seen any side effects with it.

What's a high dose?

Oh, let's say 400 milligrams a is a dose that was shown to help prevent migraine headaches. Migraine without side effects. And migraine is a mitochondrial disorder. So, I usually have people spread it out 100 milligrams three or four times a day with food. So, that's one step. The other thing is that their vitamin B3, niacin plays an important role in mitochondrial function and may be lost by COVID-19. I mean, it's in the complex biology of what this virus does, it may actually interfere with the absorption of amino acids from the intestine, resulting in an inability of the body to.

Let'S say.

A need for more niacin than you might ordinarily.

Yeah.

Is this why we're seeing, you know, benefits from NAD, from nicotinamide riboside, which is a sort of a derivative of niacin in COVID?

Yes. I think we're seeing benefits because of the direct effect of that on mitochondrial function. So, there are different forms of niacin. that I use, and it might be NAD. I also use nicotinamide mononucleotide, NMN, which has been helpful. Those are actually my favorites. Niacin itself can cause an unpleasant flushing, although some people like it. Some people happen to like that flush.

It's a dingly all over, Shelley. Right. Yeah.

Now, the niacin probably works works better when combined with an amino acid called NAC, N-acetyl cysteine, which is an antioxidant, which also protects mitochondrial function. Glutathione protects mitochondrial function, and that's a.

Major.

Endogenously manufactured antioxidant.

So when you take NAC, it helps you make more glutathione.

Right.

The NAC helps you make more glutathione. And there may be a role for carnitine, which is an endogenously made substance, a peptide, dipeptide made of amino acids. But I would say coenzyme Q10 and niacin and NAC are the main factors for restoring mitochondrial function. NAC, according to animal studies, also with the production of BDNF, brain-derived neurotrophic factor.

So.

Especially if there are cognitive issues or neurologic issues, I want more BDNF.

And.

Butyrate being made by healthy gut bacteria. Niacin can be helpful with that. And omega-3 fats may also play a role in the regeneration of nerve cells, EPA and DHA. And the data tend to indicate you need a fairly high dose for cognitive enhancement, roughly 2,400 milligrams of EPA plus DHA per day, which should be taken with food. The benefits of EPA and DHA on cognitive function are enhanced by another antioxidant called alpha-lipoic acid. And there the dose needed is about 600 milligrams a day. So, those are most of the natural products.

So, those are the natural products you use for prevention, treatment, and post-COVID.

Yeah, actually, if we take the omega-3s, there's studies from critical care units where people receiving Omega-3s have a much better outcome than people who don't.

So, that was a really extraordinary sort of description of the mechanisms and why these products, which are natural, can help to both prevent, treat, and help you recover from post-COVID. and just to summarize quickly, it was resveratrol, curcumin, quercetin, vitamin D, inositol, lipoic acid, carnitine, niacin, or derivatives like NMN or NAD, and then all the probiotics like the one that comes from the Siberian soil, others that can be helpful as well, plus upgrading your diet with polyphenols and prebiotic fibers. these are foundational ideas that are safe, they're effective, the cost is there for sure if you're taking a lot of supplements, but if someone's suffering from long COVID or from COVID the cost of not doing it is far greater, I think, in terms of our long-term health outcomes. If you love that last video, you're gonna love the next one. Check it out here. hydration is really, really important because most of us walk around dehydrated. Most of us don't drink enough water. We have other fluids like sodas and juices and coffees and teas, but we don't really have enough water. And often when we do.