FIX YOUR GUT To Prevent Disease & FIGHT VIRUSES! | Dr. Leo Galland & Mark Hyman

People who have had COVID-19 are more likely over the next three months to be diagnosed with high blood pressure or diabetes.

I really would love to hear your perspective on how COVID affects the gut and how long COVID affects the gut and how that may even affect our cognitive function.

Right, so even before that, there's a question of how the gut affects COVID.

Oh, okay.

Because studies done in hospitalized patients have looked at the relationship between the bacteria growing in the gut and the severity of COVID-19 in people who are hospitalized. And there is a definite effect because there are types of species of bacteria that have anti-inflammatory effects in the body. They're species of bacteria that impact the function of the brain. And then there are other species that are pro-inflammatory and have negative impacts on immune function and brain function. And so the absence of some of the key note species, keystone species, that really support the healthy function of the gut in people who are admitted to hospital with COVID-19, that will lead to a worse outcome and a higher risk of death, whereas high numbers of these are protective. And similarly, some of the very inflammatory immune immune modulating species may actually increase negative outcomes. So, we start with that.

Well, so you're basically you're saying is that, you know, the health of your microbiome, if there are bad bugs in there, we call them dysbiosis. I think maybe, I don't know if you came up with that term. I think you might have actually.

It's a European term, but somebody told me about 30 years ago I was the first American that they— yeah, now.

It'S all in the medical literature and it's like, I'm like, oh God, now they used to laugh at us for that term, right? And, if someone has this imbalanced flora with bad bugs that are inflammatory, what I hear you saying is that because the microbiome regulates our immune system and there's these inflammatory microbes in there, that if you get COVID and your gut.

Isn'T healthy, you're in worse shape than if you had a healthy gut.

Yeah, that appears to be the case and it certainly makes sense. And, the converse is true, right? The converse is true. If you have all the good bugs, then you may not get as sick.

Right, yes. That has to be studied in a more systematic fashion, but that's what we see from people who are in the hospital.

It's amazing.

In addition to that, there is the impact of COVID-19 on the gut, and that's complicated.

Before you get into that, before you get into that, I just want to tell a little anecdote about a similar story that I heard. not related to COVID, but there's a phenomena that's being described called newborn gut deficiency syndrome, which essentially is the result of antibiotics that have destroyed a particular strain of bacteria called Bifidobacterium infantis, which is critically important for development and regulation of the infant immune system in the gut. And the milk, breast milk contains 15% of its calories is a food that the body, human body can't digest, it feeds this particular bacteria. And since most women in the world have taken antibiotics, they don't have this bacteria because it's very sensitive. And then these kids without it get allergies, asthma, autoimmunity, inflammatory diseases as a consequence of not having this protective bacteria. So it's a very similar story, different diseases, but I just wanted to say this is not a new idea. that this is well researched data on how imbalances in the gut flora, lack of the good stuff, or too much of the bad stuff in there can cause significant consequences for our health. And we're seeing that with COVID So, sorry to interrupt, but go on the next point you're making about how COVID itself affects the gut.

Right, so if you take people who've had COVID and look at what happens to the, Organisms in their gut, there are a few things that we see and they're not surprising actually because they've been described in, you know, they act, that actually is one of the areas in which chronic fatigue syndrome and long COVID has a lot in common. There is not only, there's a loss of diversity of microbes, there is a loss of these beneficial bacteria, there is an expansion of pro-inflammatory bacteria, and there's an expansion of yeast. and yeast and other fungi actually become more diverse in the GI tract after COVID-19. In addition, the loss of some of these beneficial bacteria may create this condition called leaky gut, which is an increase in the permeability of the intestine. We know about the intestines as organisms that are necessary for digestion and absorption of nutrients. but they have this very important barrier function. And it is a breakdown of the barrier that causes the increase in permeability that's now known as leaky gut. I mean, 30 years ago, gastroenterologists would say to patients of mine, there is no such thing as a leaky gut.

Now, I mean, the term is used.

In the New England Journal of Medicine. I don't have it all over me. That's so true. But it is pretty wild to see that. And the leaky gut of COVID-19, has been associated with an increased incidence of heart disease in COVID-19. So there's a gut-heart connection with COVID.

So.

One of the things I try to do in preparing people for COVID, in treating COVID, and definitely in working with long COVID, is to improve the balance of gut bacteria. and, you know, that can be done with diet, probiotics and prebiotics.

It's really the foundation of functional medicine. It's really the place we start. And, you know, one of the things it reminded me of when you were talking about this is a particular bacteria. And I wonder if there's any data on this in covet is, it's one that protects the, the barrier and creates a mucus layer. That's really important. And it's, it's got a big fancy name called akromancia mucinophilia, but it's a particular bacteria that we now come to understand that is highly important in protecting the gut from leaky gut and is involved in metabolic health and autoimmunity and cancer. Is there any data on low acrylamide and COVID or do we know yet or maybe it was too early?

Yeah, it is too early. I haven't, I've looked for it. I haven't seen the acrylamide.

I bet you.

The particular organism and it has an even harder name and less familiar that has turned up, which is a friend of acrylamide, But an even bigger friend of Bifidobacteria is something called Faecalibacterium prausnitzii.

It's a Polish bacteria?

It's a Polish bacteria, right. And it is a major producer. It is like Akkermansia, it is one of these keystone bacterial species that supports the whole community. What the F-Prousnitzzi does is it is a major producer of a short-chain fatty acid called butyrate. Butyrate does two important things, well, to several important things. It nourishes the lining of the large intestine. 70% of the energy that is used by the lining cells of the large intestine is generated from butyrate. not from sugar, for example, or glucose. Butyrate is the substrate that it uses. But butyrate is readily absorbed into the body. It passes throughout your whole system. It has anti-inflammatory effects and it gets into the brain. And in the brain, butyrate has a genetic effect or an epigenetic effect.

It.

Allows the activation of a gene that produces a protein called BDNF or brain-derived neuroprotective factor that is essential for nerve cells recovering from injury. So, a lack of butyrate will impair the brain's ability to recover from inflammation, infection, or injury, whereas an abundance of butyrate will activate this gene that produces BDNF. And there are a lot of animal studies that have shown this connection. And I'm certain that it applies to humans as well.

So this is just amazing, Leo. I understand every word you said. I'm not sure everybody else did, so I'm just going to do a little translation. And this is just mind blowing when you start to think about the interconnections of every system of our body. So, you got this special bacteria that when it eats your food, its byproduct is this molecule called butyrate, which is basically not only giving energy to your colon, but it's absorbed, goes to your brain and turns on miracle grow. So, that all your brain cells have more connections, you make new brain cells and more connections and repairs the brain. so then the question is, well, what makes that bacteria grow? What do you have to feed it? How do you get it? How does that link up to your diet? And so all of a sudden you begin to sort of see these patterns of connection of how we begin to influence our health in a totally different way. So, for example, for Akkermansia, that particular bug loves polyphenols. It loves cranberry and pomegranate and green tea. That's what it likes to eat. and you feed it that, it'll grow. What about your Polish bacteria? What is it like, sauerkraut and bratwurst? I'm like, what do you... Actually, well.

Sauerkraut, first of all, sauerkraut is a great source of lactobacillus bacteria. But the F. Pravus nitsy, really, it likes prebiotic starches.

Basically like, like what?

Well, like beans for example, vegetables. It likes vegetables.

And, there's a whole host of prebiotic foods like asparagus and artichokes, plantain and Jerusalem artichokes and all these foods that we can eat in our diet.

Avocado enhances its growth and it produces butyrate which is then food for the bifidobacteria.

Wow.

So, I mean, the level of connections is astonishing when you look at these things. And so, definitely working with diet and the microbiome is a key part of all stages of dealing with the pandemic.

Okay, so we kind of thank you for that. We covered as much as I think we can in this moment of what long COVID is, what the symptoms are, how it works in your body, and what it causes. Now let's get to the good news, which is what you've discovered about how we can use functional medicine, diet, lifestyle, supplements, medications to actually help to one, prevent it, and then to help you with when you have COVID and to make sure you don't get long COVID or if you have long COVID, How to resolve it. So dive into what you've really learned about this. I know you've got these courses on your website. Everybody should go look at it drgallin.com this is a teaser. I mean, you've got hours and hours of content of Leo explaining this if you want to get really nerdy about it. But one of the scariest aspects for me is not the fact that you could get COVID and yes, you know, we're seeing death rates of 1%, you can argue this or that. Most people survive COVID. But what's really scary is that the post-COVID phenomena that's happening is at a massive scale. I mean, I've seen data anywhere between 20 to 50% of everybody who gets COVID afterwards doesn't get back to normal. They have what we call long hauler or post-COVID syndrome where they may not even had a bad case of it or they could have had a severe case of it, but they're having this huge aftermath of symptoms where they have headaches and brain fog and muscle aches and all kinds of physical symptoms that are really impacting their life. It's almost like chronic fatigue syndrome. So can you talk about how we're beginning to understand long COVID, what the definition of it is, are there criteria established, what are we seeing and then let's get into what it does. And we're going to go through not only just the disaster that it is, but actually the fact that with functional medicine and an approach that Leo and I are going to talk about, there's a way out. And I have treated many of these patients. I know you have too. And I've seen these patients see traditional doctors, get traditional care, and just not get better. And when they learn how to use the model of systems thinking and functional medicine, they can get better. So start with the definition of what is long COVID, is there criteria and what's it doing to the body?

Well, the criteria are pretty broad and it's not well defined at this point and there probably is not one syndrome. The name that was assigned by the CDC is post-acute sequelae of SARS-CoV-2 infection. They call it PASC or PAS. And the implication there is it's anything that happens to you after you've had COVID, probably looking at a period of say 90 days after the infection. Originally it was 30 days, then it became 60 days, now it's 90 days. So the question is how has your health 90 days later been impacted by having had this infection? And I think there are several different things going on. Someone who was really sick, who was in the ICU, who might have been intubated, we expect that it's going to take that person some time to regain their health. And some part of it might just be the post-critical illness syndrome. But there are people with pretty mild to minimal disease who weren't very sick, sometimes even asymptomatic, who are showing late sequelae that have a really broad range of findings. And it goes beyond chronic fatigue, ME, that kind of CFS syndrome. Yes, there are people, probably the most common is the chronic fatigue, maybe with some brain fog, possibly muscle pain. Then there's the whole respiratory complex, people who get winded easily, have a chronic cough, and that may actually represent some persisting lung damage from the COVID But then there are these other phenomena. People who have had COVID-19 are more likely over the next three months to be diagnosed with high blood pressure or diabetes. Sometimes diabetic ketoacidosis has occurred late after COVID-19. And that may be due to direct damage to the pancreas from the COVID that is people who suddenly go into, who look like they have type 1 juvenile onset diabetes. The type 2 diabetes probably involves another mechanism similar to what causes the high blood pressure. And then there's the impact of COVID-19 on the brain. and this is in many ways the scariest from my perspective and also pretty well studied. It is mostly in the UK. So studies have been done in the UK, they have this thing called the Biobank database and they had about 40,000 people who had MRIs of their brain shortly before COVID-19, before the pandemic. and before they got sick. And so the researchers offered many, about a thousand of those people, the opportunity to have a repeat MRI of the brain, let's say 18 months into the pandemic or a year into the pandemic. Now about half of those patients had tested positive for COVID-19 at one point and the other half had not. and they found that the people, and they call, you know, they control them for age and sex and the interval between the scans. And what they found was that people who had had COVID-19 independently of whether they thought they had long COVID or not, had changes in the MRI that were not found in people who had not had COVID. These are changes over the period of maybe a year, and there was an actual loss of brain cells, gray matter, in certain parts of the brain that are especially associated with higher cognitive functions. Now, some of these are part of the brain circuits that are involved in smell and taste. And so one of the authors of this thought that because loss of smell is such an important symptom with COVID-19 and it appears to be due to actual damage to the olfactory nerve, which regulates the sense of smell. That the entry of the virus directly into the brain through the nose was one likely mechanism for these brain changes, brain damage. But there was real brain damage there. Now they did another study in the UK which was different. They did cognitive function tests, what's called neuropsychiatric testing in a large group, thousands and thousands of people. It was done online and they controlled not only for age and sex but ethnicity, underlying pre-morbid conditions, level of education and they had thousands of people who had tested positive for COVID-19, thousands of people who hadn't. As a group, the people who had tested positive, positive for COVID-19 had deficits in higher cognitive functions that really correlate pretty well with the changes seen in the MRIs. So I think these are significant changes. They're not like, oh, here's a random abnormal lab finding. So that is really a very scary scenario to be seen as to how often this occurs. I mean it's hard to say, I would say it probably is roughly 30%. Although there are some studies showing a smaller percentage. Now in my own practice, I really try to, if I haven't seen someone in a while and they've had COVID, I will follow up with them. especially to inquire about their cognitive functioning.

Yeah.

Until I'm certain this person is fully required. The incidence of long-haul COVID is much lower. I mean, it's not nowhere near. I mean, it's two or three percent, something.

You don't think it's 20 to 30%.

No, no. The patients that I've treated that have been on my protocol.

Yes.

Beginning since they got.

Yes.

I mean, people consult me after. being sick, but people who have been on my protocol since the beginning, since they first got COVID, even if they weren't on the preventive protocol, the incidence of loss.

They do okay.

They do much better.

By the average population, I remember one study I saw early on, it was just a analysis of hospitalized patients, which is a more severe subgroup, but there was about 180 patients or something, and it's at 60 days, 87% had significant symptoms, headache, brain fog, muscle aches, all the lingering symptoms at 60 days. And I think what you're describing, Leo, about how it affects the brain and other things, pancreas, diabetes, the name is wrong. SARS means severe acute respiratory syndrome. And the mistake of that name is respiratory because what it seems like is that COVID is a systemic disease that affects every part of the body through the endothelium, through the blood vessels. And we've had William Lee talk about this on the podcast. He's a blood vessel specialist essentially. And it's just been fascinating to see how every organ, your heart, your brain, your lungs, your pancreas, and your kidneys, and your intestinal tract, and your, I mean, just everything, your skin, all is affected by the virus. And the question I would have for you is, is the virus sort of a lingering virus that goes stealth, or is this just the consequences of a train wreck that happened and lack of the ability of the body to recover and heal?

That's a really good question, Mark, and I don't think it's been resolved. What we do know is that the virus can persist in the GI tract. for months after the acute respiratory infection.

And.

How live is it? What is it doing there? We don't know that yet. There is a group that attempted to answer that question by looking at white blood cells and looking for persistence of the viral RNA this virus is made of RNA. And out of about, I think it was 30 patients with long COVID, they only found that in one patient, persistence of viral RNA. But they found persistence of spike protein in about 72-73%. So their theory was that long COVID was associated with difficulty clearing the remnants of the virus from the tissues. Now that's a phenomenon that has been described in rheumatology especially.

In other viruses and other infections.

With viruses and other infections where the infection seems to be gone, but there's all this debris of the infecting organism itself that is in tissues and that is promoting inflammation. Now that's one possible theory. Another finding, and this is very recent, actually two really significant recent findings I think in this regard. A group at the University of Arkansas identified autoantibodies to ACE2 in about 80% of people with COVID-19, including those who are in recovery with long COVID. ACE2 is a vital enzyme that has become famous because it is the receptor that this virus uses to enter cells. In my own work, I've really focused on the importance of ACE2 in acute COVID and also in long COVID, because so much of what happens with both acute COVID and with long COVID looks like a deficiency of ACE2. This vital enzyme is destroyed by the virus. The thing that was a little puzzling to me about this work at the University of Arkansas really offers an explanation is why do some people not seem to get very sick with COVID-19 but then they go on to have a pretty profound long haul syndrome. Yeah.

So, that's the thing people need to realize. It's not just the old and the people with comorbid conditions that are having this. It's young people who are healthy, I mean, 30 year olds who are robust and running five miles a day and eating healthy and then boom, their life is over.

Right, right. Yeah, I see a lot of, I've seen the number of young, let's say middle-aged, and young people who were impacted by long haul.

I'm middle-aged, I'm about the middle, I'm at 62, I'm about the middle.

Okay, all right. That's young to me.

I'm going for 125 maybe. So.

The development of these autoantibodies follows the development of the protective spike protein antibodies. So that would explain why someone might not be so sick initially, but then these autoantibodies wind up being created and that's when they get the ACE2 deficiency. It's not when the virus first enters the cells and destroys it, which happens with people who get really acutely ill.

So this is a phenomenon that happens in medicine often where you'll have an inciting agent, virus, heavy metal, whatever, a toxin that your body creates an autoimmune response to and that creates an autoimmune disease. Almost what you're saying is post COVID is maybe like an autoimmune response to the virus. And so once you get rid of the virus, you've got this autoimmune response that was really your body trying to.

Deal with the virus, but it actually it turns on itself. That's definitely true for some percentage of people who've had COVID-19 and it These autoantibodies are very common with this infection, and some of them may lead to devastating acute disease. That is, there are autoantibodies that inactivate the main antiviral defense system in the body, which is alpha interferon. And that's associated with a kind of disastrous outcome with the acute infection. This particular autoantibody doesn't occur right away. It probably takes two, three weeks. It may increase over time. And so it's probably more likely to contribute to the late symptoms. And then there are other immune abnormalities that have been described by researchers in the function of different classes of lymphocytes. And each of these leads to speculation about, well, what's the best way to treat this? And then there's some work that was done by a lab in California where they identified abnormalities of cytokines, which are proteins that are involved in regulating immune responses, and they correlated that basically with deficits in the function of cells called monocytes that circulate in the blood. What we're going to see over the next year or two or five years is that we will begin to unravel the extreme complexity of this disease. And it is, the researchers who look at this say this is so much more complex than other infectious diseases.

I mean, what it feels like is we're trying to fly the jumbo jet as we're building it. and every day we're learning something new. And the things that you're talking about, you know, the, the effect of sort of Auto antibodies, the persistent Spike proteins, the effects on the lung, the effects on the pancreas, effects on the gut, the effects on the brain, the effects on just muscle and fatigue. These are, these are debilitating symptoms for a lot of people, and, and there's a range of how it affects people from more mild to more severe. But, I mean, what percent of people do you think are, are getting long COVID? I mean, clearly, if they're following a functional medicine protocol before and during and after, and that's my experience too, is the same as you, is that they're, that's really minimal. But for the average person, what, what do you think the risk is of getting, well, you know, what does the data show?

The controlled studies are showing something like 30%.

Risk.

I mean, that is devastating because I mean, with the hundreds of billions of people impacted by acute COVID-19, billions, yeah, hundreds of millions and many more that haven't actually had a diagnosis made who probably have been infected. The potential for long-term health effects is huge. I mean, I, I, I, I, Cleveland.

Clinic and, and, and comparing notes to my other colleagues at other institutions and all over the world, and I, I, I, what I'm shocked at is that this post, these post-covid clinics are just overwhelmed. They don't know, and they don't know what to do. The doctors are just, like, trying their best or having a multi-disciplinary approach, and they're trying to figure it out, but it's, it's just not, it's just not clear what what they need to do.

And.

It'S horrible because they're really recognizing it's a problem, thank God, but they're not actually equipped to deal with it because they don't have a framework for understanding the system's nature of this problem. And they're in a reductionist paradigm, so they're medicating symptoms, but they're not figuring out how to reset the immune system, how to deal with the autoimmunity, I mean, it's quite sad to me because when I know your work and what I've seen with functional medicine, there is a way out. It's not like a terminal problem, which it becomes for so many people if they don't have the right information. And, it's really why I wanted to do on the podcast because there's work being done by folks like you and others that it is showing that if you are coherent in thinking about how to restore function, how to restore health, and how to work with the gut and the immune system and all the other aspects that we do, that people can actually get better.

Yeah, absolutely. People can get better. And it's possible that even with, if there is any condition that proves the need for a functional medicine approach, it's long COVID. And you're totally right when you say that the long COVID clinics are overwhelmed and don't really have a comprehensive framework for addressing the problem.

So who are the people most at risk for this?

Well, you know, there was a study in the UK that tried to answer that question and it basically was women over the age of 50. People with a history of asthma, which is kind of interesting because asthmatics are not necessarily at higher risk. for acute COVID, but they are at higher risk for long COVID. And I've actually seen a couple of people in whom with pretty quiescent intermittent asthma, in whom having COVID-19 brings out their asthma and it becomes more chronic and problematic. And people who initially have five or more symptoms of their acute COVID-19. Those have been identified as the highest risk group.

I mean, you know, what's really staggering here in America is that, you know, we're seeing 5% of the population of the world having 25% of the cases and deaths. And, you know, today there's 44 plus million cases. That's a lot of cases. And yet it's probably an under reporting. Maybe it's double that. Maybe it's 80 million. We've had it. Yeah. And you're talking about 30% of 80 million. That's like 24 million people. That's, you know, that's like more. That's more people than have heart disease or diabetes.

I don't think we're seeing the end of this either. If you go back to the 1918 flu pandemic, There were neurologic consequences of that, which actually were described in this book and film called Awakenings, which the film starred Robin Williams and Robert De Niro.

Yes.

What was written by Oliver Sachs. And it was about these late Parkinson disease-like symptoms after COVID-19. Well, The incidence of new cases of that peaked five years after the pandemic in 1923 and were observed for 10 years till 1929. So we are not necessarily seeing the full impact of COVID-19 on healthcare and on the health of people.

No, I mean, just in terms of productivity, disability, burden on the healthcare system, I mean, we're worried about what's happening now. Right.

How many new cases of diabetes are there going to be over the next few years because of the metabolic effects of COVID-19?

Yeah, and the brain studies you mentioned from the UK about the cognitive function and the research on long-term cognitive decline, is this a risk factor now for dementia? Is it a risk factor for depression? For, you know, who knows what? I mean, what do you think?

The risk of Alzheimer's is something, I mean, it's not just people like us that are talking about that. It's the, I mean, in the conventional medical and neurologic communities, there is a lot of concern about an increase in Alzheimer's disease and other forms of dementia lying ahead. because of COVID-19.

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Check out my weekly newsletter, Mark's Picks, where I share my favorite tips for health, longevity, well-being, and lots more. Check it out and the link below. But 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. 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. 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. Dr. Pompa:Yeah. Dr. And resveratrol, which is found in a number of vegetables. It's best known as 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 like an Indian and an Italian diet basically.

Yeah, right.

Curries and red wine.

Yes. And yeah, and so vitamin D, curcumin and resveratrol are stand, they're foundation, foundation, the approach that I take.

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 were 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 ventilation.

Curcumin. Curcumin. And what were the doses?

Oh, you know, it depends on the form, roughly the equivalent of about 1,000 milligrams a day. With a highly absorbed nano curcumin, they got away with less, but I aim for 1,000 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 a thousand 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 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 dietary pattern, I think, is important, especially from the preventive perspective. The next thing 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 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.tun d r e x.co, not dot 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, backed 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 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.

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 tundrix indefinitely, it's a fairly short of course, maybe 10 days or so.

Oh, wow.

Other probiotics that help to restore the Polish probiotic fecula bacteria and nitsi. And those are commercially available. There's a strain of bifido bacteria called BB536. There's a. There's a different soil-based organism called bacillus coagulans. These have, and I talk about these on my website in a document called the Gut Microbiome and COVID-19.

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 because it's a lot.

These have been shown in controlled clinical studies to be anti-inflammatory and encourage the growth of F. faecalis. 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 deficit is that the mitochondria take a hit. 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 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 on the form of coenzyme Q10, but low doses won't work. You need a high dose. And CoQ is very safe. I have not seen any side effects with it.

What's a high dose?

Oh, let's say 400 milligrams a day 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, 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.

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

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 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 helps 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. 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, these are the natural products you use for prevention, treatment, and post-COVID.

Yeah, actually, if we take the Omega-3s, there's a study, 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 B, 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 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. What else have you found is effective in helping these people recover?

Well, it's really important, especially in the people who who have chronic fatigue. It's really important to look at this, at how their autonomic nervous system is regulating pulse and blood pressure, and to look for this phenomenon called POTS, P-O-T-S, which stands for positional orthostatic tachycardia syndrome. And what that means is when you stand up, your heart races much faster than it should. And I have a link to, a way to determine that, but it's pretty simple. You lie down for a few minutes and you check your heart rate. And then you stand up and you lean against a wall. So you're kind of resting, standing, your shoulders are against the wall, and you check your heart rate and blood pressure if you can, but anybody can check their pulse. And if you have one of those pulse oximeters, oximeters that people were using buying at the onset of the pandemic to check their oxygen levels. And yeah, and you don't have to check it yourself, but, and you just look at what happens to your heart rate as you stand for 10 minutes. If you can't stand for 10 minutes, you're, then you, you probably have this.

Yeah.

And, and I have a whole description of how to interpret that and, and what to do about it. in the video, the long COVID video. That may require medication and an graduated exercise program, but vitamin B1, thiamine, also can be helpful for pots. So that is something else that might be added to the mix.

So, you know, I have come across because I'm constantly getting patients with long COVID and with COVID itself and looking for ways that are a little out of the box. Everything you just said would be hard to argue with, really, and it's safe and it's effective and it is really reasonably priced in the scheme of things. But there are a number of modalities out there that I've seen people use that I personally use myself, plus I've also seen practitioners use, and I've sent patients to practitioners who do these modalities. And I'm just going to list them, and I'd love you to sort of riff on what you think and how they can impact post-COVID, particularly, and even COVID, hyperbaric oxygen, ozone, exosomes, peptides, and even things like, you know, plasma pheresis, ozone dialysis, and those are things that I think are a little out of the box, but I've seen remarkable recoveries using a combination of these various therapies. What's your thoughts on these things?

Well, I think if you, I mean, they are expensive and can be invasive. So, I would certainly reserve them for people who are not responding to other measures. Now, hyperbaric oxygen and ozone both are oxidative therapies and may stimulate killing responses. You know, I've had kind of mixed responses in general with those in my practice. I've referred patients for many years for them. So far, there hasn't been anyone with long COVID that I felt a need to do that with. and I had one patient who consulted me and then went for hyperbaric oxygen and was not helped by it, but a series of one is not enough to make a judgment. Plasma pheresis might be helpful in removing auto antibodies, and it's something I would consider sort of as a late, not necessarily a last resort, but a late resort. I haven't worked much with exosomes. They're interesting, and stem cell therapy is potentially interesting. There's been some work with ACE2 producing stem cells that. Wow. But it just hasn't gone very far. Yeah. and o-peptides. So I use peptides a lot in, or a moderate amount, I would say, in my practice with different types of chronic illness. I haven't as yet gone to peptide therapy for COVID-19, but I would certainly, the peptides that I've used, first of all, they probably have to be given by injection. I don't think the oral pills are going to do it. So, they need to be given by injection. It's kind of easy. It's like using insulin syringe, but you would have to learn how to do it. And, I would look at the thymusin peptides.

Thymusin alpha 1 and thymusin beta 4.

So, I've seen some very good responses to those in other conditions.

So, this is a very hopeful message. I mean, it's really depressing that there's so many people who've had COVID and thankfully 99% of them haven't died, but if 30% are permanently ill, we need a different way of thinking about this. And what you just presented, Alito, was a really an extraordinary map of how to restore function using functional medicine. And just to kind of summarize, you talked about optimizing nutritional status, let's say vitamin D and omega-3 fats. You talked about how do we upregulate and optimize immune function, including making more interfere on alpha, which is your natural antiviral systems through various phytochemicals and plant compounds that can upregulate those systems. You've talked about the gut and how we need to restore the microbiome and butyrate production. and how that works with the brain. You've talked about mitochondria as a factor that we have to restore energy production in the cells. This is functional medicine. The gut, the immune system, the mitochondria, nutrition, you didn't talk so much about toxins, which they don't necessarily play a role here. And you've talked about even hormonal dysregulation with POTS and autonomic dysfunction. These are things from a functional medicine perspective that many of us in the field have a lot of experience with them. What you've done is applied the science to the mechanisms, the underlying biology of what goes wrong with people who've had COVID and with post-COVID or long COVID. That's just brilliant. And I think for people listening, they should really have hope and understand that even though this is a scary time and a scary disease, that if you apply these methods, that they do make a difference. Now, yes, we need large trials. Yes, we need more money to study this. But, you know, I was speaking with my friend Darius Mozafariyan, who's the dean of Tufts School of Nutrition Science and Policy, one of the most published and respected scientists with NIH grants and, you know, just really one of the leading lights in the world of nutrition science and science in general. and he said, we saw that in, in our, in our school, we had nutritional immunologists, and we were studying these phytochemicals and we're studying these nutrients and their regulatory factors on the immune system and how to deal with COVID We tried to get a study going. We couldn't get five cents from the NIH from anybody to study this. We saw this right at the beginning, you know, where there's literally billions of dollars being given to vaccine makers. to actually make vaccines or to do fancy drugs that are, unfortunately, not showing that much effect, I mean, marginal effect. So, I think you're hitting on something that is accessible to everybody that's doable by most people. It's not extraordinary measures. And then, if some people get stuck, there's the stuff in our back pocket. that we may want to try like hyperbaric and ozone. I've seen great results. I want to talk a bit about vaccines because I heard this, I don't really know how strong the data is, but it seems to that if people have been vaccinated, and I'm not going to get into all the risks of vaccination and the controversies, if people have been vaccinated, it seems to prevent them from getting long COVID. Is there data that. Does that make sense?

There's a little bit of data and the prevention might be 50%. So having been vaccinated may give you a 50% reduction in the risk of long COVID. Which would be one reason to consider it.

But.

As I said, my experience has been that if you use these functional medicine measures from the time, hopefully before the diagnosis, but from the time of diagnosis, the risk of long COVID is markedly reduced, you know, down to two to three percent.

And, Leo, if people haven't been vaccinated and they have long COVID, Does getting a vaccine help?

That's a really important question. Maybe 10% of people actually feel better after the vaccine. And I've seen some or had reports from people that I've spoken to directly of some very dramatic changes occurring usually within a week after the second shot. But I also have seen people who got much worse after being vaccinated. And so that is people who had long COVID. So it's not an easy decision to make.

So, Leo, you can take the fifth on this one if you want. We have a few minutes left. I love your perspective on vaccines and COVID. And if you're willing to share, have you had one? what do you think about where we're at with and all the controversies about the risks versus the benefits?

Sure, I'm happy to talk about that. I mean, I've been vaccinated and probably would be due for a booster. I've been postponing it because I'm trying to figure out when do I want to be sick for a few days. But the and, and I read on a daily basis the responsible anti-vaccine literature and, and plus I have also, that.

Sounds like an axi-moron according to traditional science. Well, no, there, there is, like, responsible anti-vaccine literature. Okay. Explain that.

There's a little bit.

Explain that.

And, and So, or let's just say anti-vaccine literature from sources that I consider reputable.

Yeah, I understand.

And then I pursue that information. That is, I don't ever take what anybody tells me. If they cite a study, I want to go and read that study myself. And I would say that most of the anti-vaccine literature is full of holes. It doesn't really hold up when you go in and you really look at it. There are some very real and legitimate concerns, but in fact, they don't materialize now except for a few.

And.

There are some real concerns that need to be, and they need to be taken very seriously. You know, the risk of myocarditis in young men, for example, maybe they should only get one dose of an mRNA vaccine and not two doses.

And that's what bodies of scientists are now saying in Europe.

Right, right. And so that this blanket embrace of vaccines, I think, is very dangerous. and there needs to be a constant analysis. That's the way that science works. You're constantly looking at the facts and recalculating. I would say that the vaccines are indisputably beneficial in decreasing the rate of death and the severity and the need for hospitalization from COVID-19. It is equally indisputable that they are not going to rid the world of this virus and they are not going to create so-called herd immunity and the end of the pandemic. And so a public health policy that relies solely on vaccination and you know, that's a big mistake. And that, unfortunately, has been the public health policy.

Yeah.

In this country.

Yeah. I mean, I think that's the challenge is that, you know, what you said was very important. Science is about asking questions. And in, in some areas of medicine, you're not allowed to ask questions. Vaccines are one of those areas, and it's the most bizarre thing to me. The science is settled. Science is never settled. It's the point of science is to question and to create hypothesis and challenge your thinking. It's a nuanced field. The problem with the messaging, in my view, around vaccines was that it works, it's safe. Well, neither of those are true. It sort of works and it's sort of safe and it's nuanced and it's different for different populations at different times and ages. and I think we really, you know, are, are, you know, in an unfortunate situation where if you, if you even bring up a question, you're immediately shown into this camp of being like a, a terrorist, you know, you're an anti-vaxxer it's equivalent to being a terrorist. And I, and I, I personally have had the vaccine. I, I had the Jane J vaccine because I was in a hurry and I had, I didn't have time for two vaccines. and I just was able to get it. But I also, I think we need to be honest, scientifically honest, and I think the public can handle the truth. And we shouldn't be paternalistic in the way we message. Yes, we need to be simple and clear so people understand what to do. But I think what's happened now is that people are so confused because all of a sudden it's like, that scene's gonna save us. like, oh, nope, just kidding. You know, like, oh, like all these other problems are coming out. And like any medical treatment, it's got risks. We just, you know, everybody's been taking aspirin forever. I don't take aspirin. I read the literature for years and it highly concerned me that, you know, 16,000 people a year die from GI bleeding and stroke from taking aspirin. And if your cardiovascular risk factors are low, which mine are, the benefits don't outweigh the risks. And now a study came out showing that, you know, people over 60, even if they're high risk, should not take aspirin, which was given to everybody and it was considered malpractice not to give aspirin, even though there was data because of whatever the medical orthodoxy was saying. And I feel like with vaccines, we're sort of in the same boat. We really need to take an honest view. They're not good or bad. They're just another treatment that have benefits and have risks. And and you have to calculate those personally and make decisions about what feels good or not to you. But I think, you know, I also think, and I would love to ask you this question, but I don't have enough personal or experience or patient experience to really determine this, but I have a few, is if people have side effects from the vaccines, does this approach that we just talked about also help them? recover?

Well, I'm seeing a lot of people with vaccine injuries, you know, who are coming in to see me.

And.

Yes, I think it can be, I think the approach that we've just talked about can be really helpful with vaccine injuries. I think a lot of the vaccine problems are in fact related to the nature of the spike protein. these are vaccines that introduce through some mechanism or another spike protein into the cells of your muscles, which then actually spreads, gets the lymph nodes, may circulate.

And.

I think it's very irresponsible of the conventional medical community to act as if, oh, the spike protein, it's no big deal. It's been modified. It can't affect you. I think that there are effects of the spike protein on immune responses that are very similar when you look at the vaccine or when you look at COVID-19. Now, that's a theory, and I'm basing it on indirect information. it would be a reason why.

Treatment.

Approaches that can work for COVID-19 or for long COVID may be applicable to vaccine injuries.

Yeah, I completely agree. So, thank you, Leo. You've done so much work to learn about this and share with everybody and with the general community out there with the functional medicine community. And the Institute for Functional Medicine has a task force on COVID and has really been producing content and let me know you've been helpful with that as well looking at how we deal with prevention with treatment with post covid I encourage people to check out that resource ifm.org and check out your your website dr. leo galland sorry drgalland.com that's just d-r-g-a-l-l-a-n-d.com it is a treasure trove of information you you you are you know you know not a radical you are a thoughtful scientifically oriented Doc, who has asked hard questions, who's challenged orthodoxy, and I really deeply respect your ability to sift through all the noise and look at what science says and come up with things that are common sense, that reasonable, that under mechanistically sound, and that can really help people. And, I'm just going to confess personally, I, I, well, if it's confession or whatever, I, since this all started, I wrote an article probably in March of 2020, as soon as this came out. And I wrote pretty much everything you said to take and do. I wrote, I wrote down because it, there, there was evidence there that all those things work. And personally, I take almost everything you, you had just described. I don't take some of those Siberian probiotics, but I'm probably going to get them now. But basically, I take almost everything you're talking about. I take hercumin, I take CoQ10, I take a lipoic acid, I take NAC, I take vitamin D, I take fish oil. I take probiotics. I take mitochondrial support. I, I do the things that I know that are going to strengthen my system. I take quercetin because I, I know that, that I don't want to get covet. If I get it, I don't want it to be bad, and I don't want to get post-covet and, you know, not what, but I'm good, you know? So I think that, that I feel very hopeful that if people listen to this podcast and that they can digest the first part, which was pretty heavy, that the second part, we really unpacked a way of living. And we didn't talk about the importance of, you know, deep nutrition and exercise and stress reduction and sleep. Those are sort of self-evident ways to help your body. But if people can understand that, you know, they don't have to feel helpless and wait for some new great new discovery of a drug, that there's so much that you can be empowered to do right now to make yourself COVID resilient. to help yourself recover from COVID and to prevent and treat post-COVID syndrome. I mean, that's a miracle.

So, yeah, Mark, I would just like to talk about one of what I think is one of the most remarkable studies that was published along those lines. And this was a study that came out of Johns Hopkins, Harvard, Columbia, Stanford, top researchers. they looked at a group of health professionals, mostly doctors and mostly men, and they categorized them as people who had recovered from mild COVID or people who had had moderate to severe COVID. But they were all people who had survived COVID. And they then did a dietary analysis of what their diets had been like during the year before they got COVID.

Yeah.

I went in and looked at the data. And you have to really look at the data itself. The bottom line is a 40% increase in the consumption of vegetables created a 72% decrease in the likelihood that someone would have moderate or severe COVID versus mild or minimal COVID. Now, if there was a drug that did that, just imagine what the headlines would be.

Yeah. 40% increase in your veggies, 70% decrease in severe COVID. The other study was on vitamin D. I don't know if you saw it, but, and I know, I think it's in pre-publication, but it was released and it showed that if your vitamin D level was over 50 nanograms per deciliter, which is probably maybe, I don't know, 5% of the population, that your risk of death from COVID was zero. Does that make sense? There's no drug that can do that, no vaccine that can do that. Literally, we should be giving free vitamin D to every man, woman, and child in America.

Absolutely. Instead, what we're seeing is all of this stuff in the press. Well, vitamin D, we don't really know. Somehow, it's not okay to advocate vitamin D in this situation, but it's perfectly okay to advocate vaccines for everybody.

That's right. Although when, when President Trump got covid in New York Times, they reported they were giving him vitamin D and zinc and all the other stuff. Yeah. We're talking about. If you love that last video, you're gonna love the next one. Check it out here. Inflammation, which is what I had, right? Widespread inflammation in my nerves, inflammation in my gut, inflammation in my brain, in my thyroid. Exactly. It doesn't qualify as a treatable disease. Inflammation. Right. That's what I was joking, say functional medicine.