Dr. Paul Anderson explains why there's no single lab test for long COVID. Instead, clinicians should assess eight domains including immune function, persistent infections, hormonal balance, and gut health, with testing depth matched to symptom severity.
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Basically found well there's no difference between people who've had other viruses and people with you know long COVID. Well, the first thing about that is well yeah, you know other viruses can cause these problems as well. It's just long COVID is more famous and it's a little more aggressive. But number two is the thing that we see clinically is recording in progress. Hi, I'm Dr. Paul Anderson. I'm answering your questions today. So I got a great question about long COVID. Now if you haven't been to the YouTube channel, go to dranow dranow. There's links to all of these outlets, but Dr. Anne Lyon YouTube got a big question about long COVID. What's the best test and why is it so complex? So I thought I would dig into that. I'm answering questions for you today. So long COVID, the first thing to always consider is when someone says, well, what's the best test for it? The answer is there isn't one. And that's really frustrating because we would all like a simple test, maybe one thing we could look at and say, oh, you got long COVID and it's a small, medium, or large problem? Well, if you go back in, in the long COVID, you know, playlist there, you can see there, one of the first ones I did was actually called, you know, something about like my head is spinning from the research around long COVID, you know, getting vertigo from it or something like that. And the idea was I shared and contrasted 4 different papers about long COVID. And one of them went through and they did a ton of testing and they basically found, well, there's no difference between people who've had other viruses and people with, you know, long COVID. Well, the first thing about that is, well, yeah, you know, other viruses can cause these problems as well. It's just long COVID is more famous and it's a little more aggressive. But number 2 is the thing that we see clinically is it is a very individualized assessment that has to be done for long COVID. And why is that? So why isn't there one test that we could just say, I'm going to go in, I'm going to have some blood drawn or whatever, and boom, I'm going to find out, you know, if I've got bad long COVID. Well, Long COVID is a clinical distinction. It's clinical diagnosis that's made, and it's made based on how long since you had COVID, what your signs and symptoms are, et cetera. But we wanna take that to the next level. Now, a lot of people say, why, if this one paper said there's no laboratory differences, would you still check people out and do labs? Well, because there's other ways to look at this no laboratory difference conundrum that comes up. And so you say, well, why? What's the other way to look at it? Well, probably because people like myself, we've been dealing with people who are chronically ill for a long time. What you see in the chronic illness community, everyone can have the same label on their chronic illness, but they can have very different laboratory and underlying triggers than their neighbor does, for example. And this is real frustrating because in acute care medicine, we can take most of the people with a thyroid problem and do Same lab tests on them and we will find variations in their thyroid function, for example, or people in, you know, with an acute infection. Usually we can do particular tests and they'll reliably come out in most people the same way. When you have a multifactorial illness like long COVID or any other chronic illness problem, you now have multiple inputs that go into creating your symptoms. So you and your next door neighbor could both have long COVID or another chronic illness, the same name. And you both could have totally different reasons for the same symptoms. And that just seems wild, but that's the way it is with post-infectious illness and chronic illness. Now, if we take long COVID specifically and we look at the research around the triggers of COVID to long COVID, a lot of it is immune deregulation, inflammatory insult, and then the immune system gets sort of off track. And COVID does a little bit better than some other things, and I mean better in In the pathologic sense, it's a worse pathology than a lot of other things. What happens then is your immune system starts to go, and we deregulate our immune system when we get sick to try and fight the bugs. That's great. But with COVID what can happen is that deregulation sort of magnify and kind of burn on for a while. And then our body systems underneath that are supposed to keep us balanced and keep us healthy and help us, uh, push back against the deregulation and get better after an infection or something. Those body systems get thrown off. Now, here's a big problem. You might have really strong body systems in particular areas, but other areas might have been beaten up more. So the things that trigger your chronic illness picture, your long COVID or whatever, can be the weaker areas and the immune deregulation. And those are going to hit your weaker areas. And then maybe your neighbor's got the exact same symptoms. Your weak areas, theirs are are strong, but they have other areas that yours are strong and theirs are weak, and you get the same type of symptom picture. So that is why we feel that there's a lot of this variation in laboratory testing pattern. So what happens then is we get the initial insult, which is a pro-inflammatory normal reaction. It burns on and it gets imbalanced. Then we have a chronic Dysfunction in the immune inflammatory interface, and then we have dysfunction damage to some organs, and that creates a long COVID or chronic illness picture. So what areas are most common that we look in? Well, the first one— these don't go in any particular order— would be cell functions. This could be everything from your cell membrane being inflamed, your mitochondria not working well. You could have genomic problems in the way that nutrients are processed in your cells. You could have malnutrition. You have all sorts of stuff there for cell function. Next area would be toxins and toxicants. These would be things like, you know, mold exposure, chemical and metal exposures, all sorts of stuff like that that derail the immune system. Then there are infectious resistance factors. So infections are sort of separate category, but infectious resistance factors would be things like biofilms and other things that The immune system has either gotten behind in or been triggered to not be balanced very well, you could say. Then there's your immunology. Okay, now that could include infectious problems, but also we see a lot of people with long COVID who have triggered autoimmunity. The autoimmunity might be a global autoimmunity. It might be a specific thing like a thyroiditis type autoimmunity, but we see people who didn't have it before and now they do that they're in long COVID. That's a Whole other kettle of fish there that's different from infections and resistance factors. Another big area that tries to autoregulate you that has to come back online is your hormone system, your endocrine system. That is very complex because, of course, the endocrine system is multiple hormones and they all talk to each other and they all do different things. You think, well, what does that do with me having an infection? Your immune system, when it initially goes into the upswing, directly talks to your hormonal system to help you through the other side. For the downswing and the maintenance. Well, if you have this inflammatory infectious deregulation that goes on, like in post-infectious illness or long COVID or whatever, you're going to have downstream problems that the endocrine system, the hormone system, will try and respond to, and then it, it will be sort of pushed back. Endocrine system can then get out of balance, and we've got whole videos on that if you want to look into that more. Then there are these psychosocial stressors. You've been sick, You may have been isolated. Maybe you're the sickest person in your family and you're feeling bad about that. You've missed work, you lost your job. All of those things have direct, direct linear effects on your immune function, immune system, which is already not working very well. Another area that is really out of balance in some people is the digestive system. So that's more than just digesting, absorbing food, which is huge. It also kind of gets into the microbiome, the balance of the gut bugs that are good versus not good. We now have case reports of people People getting small intestinal bacterial overgrowth or fungal overgrowth or other stuff after this, even people, you know, growing out certain types of parasites and other stuff after, you know, long COVID. So your gut's a huge area. And then there's physical and structural things. So, you know, fascial planes, the movement of your lymph, the structure of your body, you know, old injuries and old blockages and stuff like that. Then the final complicating factor is Are you having sort of a small, medium, or large problem with your post-COVID or post-infectious illness, chronic illness? If it's kind of on the small end, a lot of times basic things can be very helpful. If it's a medium or large problem, it's gone on a long time, it's very complicated. Those are the people where we normally have to take a step back and say, well, we've done basic labs, but we haven't maybe looked too deeply at some of these areas. Maybe we should screen for mycotoxins from mold or some other toxicity. Maybe we should look at these endocrine dysregulations or the GI tract, or maybe we should look at all of it. And it's only then with the medium or large size problems, the ones that keep going on and you're treatment resistant, do you start to see patterns that can come up. And like I say, you and your neighbor can feel the same way, have the same symptoms, and have totally different labs and different patterns that come up. So while that is not what the person was asking for, was what's— which test is best for Long COVID, it explains why you need a healthcare provider who works with chronic illness, etc., because they're more likely to look into these sort of interconnected problems, especially the longer you have a chronic problem like Long COVID, post-infectious illness, other chronic illness. We always put down below in the links on the YouTube channel links to provider referral sources. And remember, what I talk about is just what I see in practice, my experience over a number of decades, and what I see in my COVID, long COVID, and chronically ill people. It's not meant to advise you. You get your advice from your own healthcare provider. Thank you very much. Dr. Paul Anderson with Medicine and Health. It's been my pleasure answering this question today. Check us out on dranow.com, D-R-A-N-O-W.com. That is a hub website. So if you haven't been over to say the YouTube channel, you can get click over to there. Whatever way you're consuming this media, please like, share, and subscribe. And do notifications and do comments. All that helps us with the algorithm, and specifically over at YouTube, we're really trying to grow that particular community as well. So check us out over there. Just go to the hub website, dranow.com, dranow.com, and I will see you on the next installment.
