Long Covid Update

Management or other advertisers. This is contacttalkradio.com, consciousness in action, and you are taking action into your consciousness by tuning into Contact Talk Radio. And on tunein.com, hang.fm, and UpSnap Mobile. Contact Talk Radio. Welcome to Medicine and Health with Dr. Paul Anderson. This is a show about opening up the often mysterious world of how doctors think. The goal: to empower the listener to gain access to the best healthcare possible. Good day and welcome to Medicine and Health with Dr. Paul Anderson. That's me, I'm Dr. Paul, and today it's about COVID long haul or post-COVID syndrome or COVID long hauler or any of the other names that, uh, we have come up with, uh, the post-COVID experience. It's not so good for a lot of people. So I got so many questions about this particular topic, um, and as you know, in this particular channel, whether it's live on the radio at CTR or live through CTR as a Facebook Live feed or a Facebook Rewind, or eventually we get over to YouTube and where we save everything, or maybe on a PodBurner. Uh, my main goal with these programs is to answer questions, and they're really good questions. And when you get to a topic like post-COVID illness, it's a topic in evolution because it's something that of course is a newer disease experience, although the idea of post-infectious illness is a very old disease experience. But when we're thinking about post-COVID syndrome, the specifics for the people going through a post-infectious syndrome with respect to COVID is unique in many ways and similar to other post-infectious syndromes in other ways. What I wanted to do is a couple of things to bring together a lot of questions that I've received over time. Now, in, uh, gosh, I think it was about a year ago, I did a, um, training, uh, for healthcare providers in regard to, you know, what to think of, what to look for with respect to post-COVID syndrome or post-viral illness, because this was the area that I treated a lot, uh, especially with the chronic ill patients that we had. Interestingly, there was a lot of crossover even in the cancer survivors that we would have. I had a lot of experience with it. Well, when it came to post-COVID, a year ago, we were just getting our head around what might be going on. What I wanted to do is not only answer these questions that I've gotten, I've got lots and lots of things written down in here, but also update some of the information that I've seen just in the past year with respect to post-COVID. And also, you know, what does it look like timeline-wise? Because a year ago, that was something that was much more unclear, was, you know, is this a short-term thing, long-term thing, et cetera? And then talk about some of the underpinnings. But the other reason I wanted to do this is Uh, so this, if you're listening live or anywhere near live, this is October 7th, 2021. Uh, so if you're listening a year from now, everything could be different. Uh, you know, in some cases with COVID if you're listening a week from now, a lot of things could be different. But there's a lot of things that actually have stayed the same. Well, um, later, uh, next week, so just about a week from now, I will be presenting a scientific presentation on post-viral illness specifically related to post-COVID syndrome to the American Academy for Environmental Medicine, the AAEM. They asked me if I would do a presentation on this and I said yes. I took all my collection of papers and scientific information, took a lot of personal experience working with patients, and then more importantly, probably the experience of other people. Because there is a thing even as a doctor called selection bias, where, you know, we tend to attract certain types of patients. So we might think, well, you know, what we do works really well for everybody when it's just working for our type of patient. Uh, so it's good to check around and see what is and isn't working amongst those around you. So this AAEM scientific presentation, I thought, well, why don't we take the high points out of that And distill them down in a way that answers these many, many questions that I've gotten and have come in. So I think that the first thing to look at and to deal with question-wise is looking at, okay, what is COVID long haul or post-COVID syndrome or post-COVID illness? Um, and what is the experience for the patient? Now, if you look statistically at anything, you get this spread of symptoms. And the one thing you have to keep in mind with symptoms is, uh, you may have more of one end of the spectrum of symptoms and someone else might have more of another. But if you look at a breakdown of the top 10 symptoms and the percentages of people that have, you know, symptom 1, 2, 3, 4, or 5, it stands to reason that if, you know, 90% of people have one of the symptoms, that you're more likely to get that than a symptom that only 10% of the people have. But it doesn't make the symptom that only 10% of the people have not worth anything or not worth thinking about. It just means less people have it. happen to have that when they've surveyed them. Now, one of the things you have to be careful with, with respect to post-COVID syndrome or anything around COVID really, because it's an emerging disease, even though we've had it with us for, you know, going on 2 years now, um, is the, the statistics can say this, you know, this is true at this moment. All the statistics mean is this is what we studied and this is what we found. It doesn't give you ultimate truth. So if I share, you know, I'm going to share some statistics and things from papers and whatever, that just means that when they were looking at that, when they're doing the study, if they did it correctly, they answered a particular question and said, you know, this is associated with, or this seems to cause, or this is a symptom pattern, etc. It doesn't mean that nothing else is possible. Okay, and that's something that I saw early on. Now thankfully, doctors are getting a little bit more aware of post-viral illness, post-COVID syndrome. We've had post-viral illness forever, as long as there's been humans, uh, but post-COVID syndrome, doctors are getting more sensitive to it because they're seeing more and more patients with it. And so, you know, in the earlier days it was like, oh, you know, go away, or this is a psychiatric problem, it's all in your head, or whatever. And none of that is true, and none of that's helpful. Certainly to share with people. So the first thing is, is that post-COVID illness, long COVID, COVID long haul, is a classic post-infectious disease syndrome, more specifically a post-viral syndrome. Now, many people have had other viruses. If it was, let's say, a cold, you know, an adenovirus or something, uh, and it wasn't that bad. You might have no post-viral problem. You feel sick for whatever amount of time, you're stuffy, you've got aches and whatever, and then you get better. But many of us, uh, have had one of the influenza strains, and if you had like influenza A, usually the more, uh, nasty kind, or one of the unique influenzas like H1N1 or H5N1, You may have been extremely sick, and what you may have noticed is you recovered from the viral illness, but you had lingering symptoms that went on after. That's all a post-viral syndrome is. And so if you think about that, that a post-viral syndrome is you are technically over your influenza or your COVID or whatever, But now you have these other symptoms that will not leave you and will not go away. Why would that be? And why with COVID specifically is it so nasty? And why does it hang around so long? And why can it affect so many organs in my body? You know, people will say, well, I, you know, I thought this was mostly like a respiratory illness. Why do I have brain fog? Why, why am I having clotting? Why am I having all these other problems? Well, that's because of the nature of the virus. Okay. The other thing about a post-viral illness is it may come in one way while you have the primary illness and may leave giving you a post-viral illness that has different symptoms or maybe just a few of your original symptoms. So if you go through and you look statistically at the top 3 symptoms in long COVID or post-viral COVID illness or post-COVID, COVID long haul, whatever you want to call it. We'll just probably call it post-COVID from here on out. The big 3, although again you can have anything that your body wants to have, are fatigue, cough, and headache. Now you don't have to have all 3. Many people do, but those are the 3 most common. But what other things do people have? People will have shortness of breath or difficulty breathing for quite a while afterwards. They will have joint or muscle pain. They can have a lot of chest pain. They may lose their smell or taste or both. And often, as you might remember, that's one of the things you often lose during COVID Well, that can extend into the post-viral time. They can develop dry and red eyes, one or the other or both. Dry eye syndrome, red eyes, usually they go together. Chronic runny nose, rhinosinusitis that goes on, chronic throat pain. And as I mentioned, along with joint pain, it's not uncommon to have muscle pains, aches. a flu-like feeling, really. Well, if you look at those symptoms, you might say, well, gee, you know, I once had the flu real bad. It was probably an influenza A type where you were sick for 1 to 3 weeks and you're pretty sick and you started to get over it. And then you noticed that you were just like walking through mud every day for 2 or 3 or 4 weeks afterwards. And you would get headaches maybe, and you would have other things going on. Why is that? Well, that's because the virus comes in and maybe, maybe all— for all intents and purposes, the virus has left your body. Now what you have is a leftover residual in your body trying to still recover from the flu. So then you say, well, gee, that's no fun. I was really sick for 2 weeks with influenza A, and now I'm not— supposedly I don't have any more influenza, but now I feel horrible. It's exactly the same thing with COVID Now, what are some other things that go on? So a symptom is something that, that you report, okay? It's something that you say, you know, I have this thing going on, I've got a headache, I've got fatigue, etc. A sign— so they say, talk about signs and symptoms— a sign is something that, that someone else can objectively see. So sometimes they can be the same thing. You could say, I have a cough. We could listen to your lungs and hear a cough, for example. But there's other things that you might not feel as a symptom, but that can be going on. One of them that's very critical is the thickening of your blood and the potential for formation of clots. Now you may or may not have symptoms from clotting. Of course, if the clots go to the wrong place, if it's in your heart, you can have a heart attack. If it's in your brain, you can have a stroke. If it's in your lung, you can have an embolus. If it's elsewhere, you can have other problems. But what we see with a lot of people is they have residual types of clotting problems, and those might be resident in their lungs. And then the lungs may be having trouble moving air because the clot is not allowing enough perfusion of blood to go in and out of your lungs so that you can turn over oxygen. The same thing can happen with your brain where if you get microclots— now, if you get a big clot in your brain, you're going to have stroke symptoms and you're going to have other issues, but you can have microemboli due to COVID and many other things, but COVID especially, and you can have other problems. It can lead to brain fog, it can lead to aphasias and other deficits in your brain activity. So some people after COVID and during might be put on anticoagulant drugs. That's not uncommon at all. Well, that's because there's maybe not a symptom that you notice right away, but the sign that you might see on imaging or through some other means is that the thickness in your blood has created this clotting. And I've seen that with a lot of people where if it, uh, let's say it hit their lungs really hard first, which is not uncommon, they may have a residual cough and low oxygen levels and other stuff because they have clotting in their lungs afterwards. So these signs and symptoms go together, although they might be different just because of the way a sign and a symptom really is. Now, there are many, many other things listed And one of the things in the professional presentation that I'm going to be doing next week to the AAM, I'm going to go through the statistics on a lot of these, and I'll give the audience— you know, there's one study group that did, oh gosh, it was probably 30 to 50 different symptoms, and they graded them in a fairly large study of people and how common they were. But those are the big ones. So nobody wants any of those things. You don't want a residual cough, you don't want a residual headache, you don't want to feel like you're walking through mud and you have fatigue every day. You certainly don't want the loss of taste or smell to go on and on and on, and to have chest pain or runny nose or any muscle aches, etc. Nobody wants to do that. So— The next question really is, okay, if that's sort of the post-COVID experience, keeping in mind it'd be many more things than that, uh, it can have those plus other things, and there's these, uh, physical biological signs in your body that can be either triggering those symptoms or making them worse, like clotting, uh, like other inflammatory things, etc. We're going to talk about So it's a big, big collection of things that go wrong. Now, one of the big questions I got was, well, okay, I either had, 'cause a lot of people ask the same question. So some people would say, I've had or I've got right now long COVID. I'm pretty clear on the symptoms I have, but I also know a lot of other people who have lived through it and maybe they got over the symptoms or they still have long COVID. Why in the world does this COVID leave me with such bizarre symptoms, and my friend over here who seemed to be just as sick as me is left with different symptoms? Well, that owes to a couple of things, but one of the, uh, one of the— Really important criteria is that the way your body deals with the insult from the infection from COVID is going to be different than the way that your neighbor does, potentially. Now, we think of SARS-CoV-2, so COVID-19, or COVID as we're probably just calling it right now in 2021, we think of it as a respiratory inlet virus, meaning we probably breathed it in somehow and it started in the lungs, etc. That's generally how we get it. But why then do we have some people get a multi-system inflammatory disease? Like a lot of, uh, children who got sick, the lungs were a little bit bad, but really their whole body kind of lit up with this multi-system inflammatory illness. And early, you know, a year ago, they were saying, you know, it looked almost like Kawasaki disease which is a fairly rare disease that happens in children due to other insults, but that COVID was hitting some children like that. And then there were some adults where it really seemed to affect their nervous system more than their lungs or their heart. You know, I mean, your heart and your lungs have a lot of connection, a lot of crosstalk, but sometimes it wasn't so bad in the lungs, but the heart— you know, really took a hit. And sometimes all those systems were a problem. Why in the world would one virus do that? Well, there's a lot of theoretical reasons. There's a lot of science that we understand with respect to how COVID gets in and, um, what it does and all of that business. And, um, you know, there— and what I'll say is, if you listen to this point One of the things, and I know it might surprise some people, I have to say this out loud, but one of the things that you need to understand to follow through the rest of this conversation is that you do need to believe that the virus is, is an actual virus that happens. Okay. So the coronavirus family has been around, you know, forever, pretty much. We've all had different types of coronavirus in our past. as humans. Uh, this is a particular coronavirus that, you know, left humans, as many do, and gained a lot of function— gain-of-function activity. And now it's back and, and it's, it's infecting humans here and causing the disease, you know, COVID-19, or just COVID, and then long COVID. The reason I mentioned that is sometimes I'll get, you know, comments on YouTube or on Facebook or whatever And people say that the virus doesn't actually exist at all, and, you know, I'm, I'm just telling stories. Well, you know, the virus does exist and it does do all of these things. Now, you can argue about lots of other things about the virus, but you need to understand it is a real problem for people. Um, so a couple of big things though that I would like to explain with regard to how could it go in and hit a lot of people just in their lungs. and hit other people in their heart, their brains? And how could it hit children and adults all over, a multi-system inflammatory disease? One of them is a pair of, um, what you can think of as chemicals in your body that are already there that get manipulated, okay, during the experience with COVID Now, one of them is called, uh, furin. Now, furins are an enzyme in your body that are already there. They are supposed to be there. They are supposed to help with cleaving particular proteins and all of that. And so you think, well, all right, it's— so it's an enzyme that's already there. Why is COVID and furin maybe a bad combination? Well, One of the things about COVID SARS-CoV-2, is that it has a special ability it developed somewhere in its evolution as a virus, where it has the ability to block or cut off, cleave a furin binding site, which might normally if that ability wasn't there, might make the virus weaker. But then the other problem is, um, in, in pathogenic organisms, many of them, like some of the nasty other viruses, uh, some bacteria like anthrax, other bad things you've heard about, they find a way to use something we already have in us like furin and use it against us. And so it actually makes it more— instead of the protein cleavage happening and maybe weakening the virus, the virus finds a way around that and turns the presence of furin into a pro-viral activity, or in the case of anthrax, a pro-anthrax activity. And so that's not good. Now, an unthought-of consequence of this furin business was There are people who naturally have higher levels of furin proteins and they have other diseases. And that's normally not a big deal, except that they have those other diseases until you put COVID into them. And then because COVID now has this ability to use furin enzyme for a pro-COVID purpose instead of pro-people purpose. Now, if I'm one of these people with high levels of furans in my body already, and then I put COVID in, bang, I get this explosion of pathogenicity. Well, guess who has the most furans in their body already? You've got people with diabetes, high blood pressure, and other heart disease, obesity, and other things that we've said from the beginning. aren't good to get COVID if you have those things together. Well, it turns out, and that's not the only reason, but one of the reasons is that your body, because it's got this chronic problem of a heart condition, diabetes, obesity, etc., you got a lot of furans in there because of the other disease. And then if they can make the COVID virus, because of COVID viral genome engineering, if they can make the COVID virus actually work better instead of worse, bam, you've got this worse experience. So people with high furans are one of the groups. Now, does that happen 100% of the time? No. I've seen plenty of people who have type 2 diabetes, they're considered overweight, low obesity, maybe even some heart disease, they get COVID, They're sick for 2 weeks and have no post-COVID syndrome, and they live through COVID with no medical care. So it's not 100% of people. It's just statistically, if you look at now that we've done more stats over time, that the more comorbidities you have, such as higher body weight, diabetes, heart disease, etc., etc., the more likely you are to be sicker and the more likely you are actually to have post-COVID syndrome. So it's not 100%. So, you know, I've seen papers written and say, well, you know, that theory doesn't pan out because not everybody gets it. Well, that's not how that works. But that's one thing. Then the next one is this thing we have built into us called bradykinin. And bradykinin is from the kinin family, uh, and, uh, it is essentially, uh, a messenger, uh, molecule in your body. And just like the furin story where it does something without COVID that, you know, is probably helpful if we get sick, etc., bradykinins get increased when we get COVID. Okay, great. But what bradykinins also do is that they shift the angiotensin-converting enzymes, the ACE. You've heard of like ACE, and, uh, there's this thing with COVID and the ACE receptors and ACE enzymes, and they tend to make each other worse, right? What happens is the bradykinins, which are released when we get sick, etc., change the ACE. And in other illnesses and infections, the ACE family is less involved. Well, it turns out that the bradykinin effect on the ACE changes makes our blood vessels more inflamed and leaky. So if we get it in our lungs and it's raging in our lungs, we now have leaky, inflamed capillaries, blood vessels in there, and we start to be able to breathe less and less, move less oxygen. Now, your lungs being inflamed is the last thing that you need, because without the movement of oxygen and CO2 in your lungs, you die. rather rapidly. This is one of the reasons why people wind up getting into respiratory distress. And so just like with, you know, the furins, where if COVID's not there, it's maybe an issue but it's doing its own thing, well, bradykinins are usually increased when we start to get sick. Turns out they kick up this ACE system that kicks up inflammation, and it tends to affect the lungs first. Now, angiotensin-converting enzyme is highly represented in the lungs, although it's everywhere else in your— not everywhere, but almost everywhere else in your body. You can find ACE receptors in many, many other places. It's just that if you get a virus, it comes in usually through the lungs, and the bradykinins, the other inflammatory stuff goes up, and then bam, you've got big thick, you know, inflamed, leaky lungs, you're going to have other problems. Now the other thing that happens when the bradykinins rise because the COVID being there is that you get this synthesis of something you've probably heard about. Some people even take it as a supplement. Uh, the rheumatologists or orthopedic surgeons will sometimes inject it into your joints even called hyaluronic acid, or there may be other things that they do around there. Well, hyaluronic acid is great if it's in the right place at the right time. What happens with this increase in bradykinin is the hyaluronic acid gets into your lungs where the air should be, and, uh, that is not good because it is not something that you can move oxygen and carbon dioxide through. So you get an increased synthesis of hyaluronic acid and a decrease of breakdown because the bradykinin activity triggered by the COVID Again, another reason why things are not going well. Now, bad enough in the lungs, horrible in the lungs that happens, but imagine if that's going on in the small vessels in your heart or your brain. Same thing's going to happen, only it's not going to be a breathing problem, it's going to be a brain problem, neurocognitive, etc., or, uh, or heart problem Or if it's in your kidneys, kidney problem, etc. The other thing, if it wasn't bad enough, that this whole bradykinin problem spins off is that you get this inflammatory response that goes through your whole body. Remember the multi-organ response? And this one is usually kind of insidious. It's, you know, behind the scenes. But it's really horrible. For the post-COVID stuff that it triggers, and that is that it starts to poke holes in your blood-brain barrier. Now, your blood-brain barrier is there for a very, very bunch of good reasons. It tends to separate most of the blood flow on one side, the body side, from the brain side, and it insulates the brain from what's going on in the rest of the body. This is important because your brain likes to control its own blood sugar. It likes to control its own availability of aminos. amino acids to make neurotransmitters and other stuff. It likes to control the inlet of good stuff and the excretion of toxins. Your brain likes to control all this stuff. The blood-brain barrier does a lot of this through a lot of, like, transport systems and things. Well, it turns out that while this increase in bradykinin and shifting of the angiotensin system is going on, you're poking holes in your blood-brain barrier. Now, That's never good. This happens a lot in people like after radiation to the brain. You might see this in cancer therapies, after certain drugs, after other infections, etc. People also with, say, Parkinson's disease or multiple sclerosis, etc., will have leakier blood-brain barriers. And the big problem is then that your neurotransmitters can't stay regulated as well. Your brain gets more inflamed. And other things happen. So if we look at the big bunch of symptoms and we look at chronic headaches and brain fog, cognitive difficulties, sleep-wake cycle dysfunction, increase of neurocognitive things, neuroemotional changes such as, you know, depression, rage, anger, you know, anxiety, all of that stuff, it Increasing your blood-brain barrier permeability doesn't help any of those things. Okay, so that's going on in the background and the foreground. Other things in your body, it turns out now we know more that your digestive system becomes incredibly and increasingly dysregulated. So your good flora and the permeability of your GI tract and all of that gets dysregulated, just like the blood-brain barrier permeability does. Now we know— we, we were proposing this a year ago, but now we know pretty sure that if you had underlying autoimmunity that maybe you didn't know about, it may come out after you've had COVID or during the COVID long-haul time period. The other thing we've known about from the very beginning, because it was easy to test, but now we know even more about is the idea that co-infections— you've heard me talk about that before. So co-infection, just simply, I've got COVID, who else is running along with it or taking advantage? So you might have a co-infection of one of the primary, uh, pneumonia organisms, you know, Strep pneumoniae or Klebsiella pneumoniae or one of those guys, or one of the atypical pneumonia organisms like Mycoplasma pneumoniae. Or one of the many other viruses, etc. Also fungal infections, also a lot of systemic viruses. Now we've got papers coming out showing the Epstein-Barr virus rises during long COVID, and many others. Well, you've heard of Epstein-Barr, you know, causes mono when you're a kid, but also can trigger chronic fatigue and other things of that nature. All of those things are a huge, huge problem. Now, in one study alone— this is one I'll be presenting to the professional group— um, just when they looked at, uh, viruses, bacteria, fungus that can cause other pneumonias, they found 24 different infectious agents that liked to superimpose their infection along with COVID And so this is not a small problem. Okay, a lot of post-COVID trouble, in my experience, is not just the inflammatory kinins and the furin problems and, uh, the clotting and all of that. That's bad enough, but a lot of it also is infections that came along or fulminated while you had COVID. and then no one checked you for them or treated them. Well, imagine if you get better from your COVID infection but you still got 1, 2, 3, 4, 10 infections that you're carrying around. How soon are you going to feel better? The answer is not very soon. You're not going to feel very better soon if you're carrying around a lot of infections. And co-infections are something that, while, uh, us doctors intellectually know about them, and I mean, certainly know about coinfectious problems, we're not often first to think— unless we work with chronically ill people, we're not often the first people to think about, gee, maybe I should go looking for some co-infections because this person's not getting better. The other problem with co-infections is there's a lot of them. And unless you're used to looking for them and doing the kind of more broad infectious disease panels to look for them, you will never find them. That is one of the axioms about infectious diseases. If you have an infection, you can have all the symptoms, but if you never go looking for the disease, you will assuredly never find, uh, those co-infections, and then the person will stay sick for a long time. There's almost a universal problem which goes back to some of these more basic things, which is mitochondrial damage. The mitochondria are little organelles inside your cells that make most of the energy. Making most of the energy is a good thing, but imagine what your body energy does when you turn all the mitochondria down to be slower. Well, everything I've mentioned up to this point— co-infections, the bradykinin system, the inflammatory stuff— that all slows your mitochondria down. But then there are other things that slow your mitochondria down too, such as collateral diseases. It's like co-infections, only it's not infectious. So changes in your hormonal system, endocrine changes. Super common. When you get sick, your body wisely shifts your hormone output to deal with being sick. If you have all this other junk going on and you've got co-infections and inflammation and everything else, your body may not shift your hormones back to normal after you get better, and you will feel that as symptoms, which can be any of the symptoms we mentioned earlier. Other things that can be deranged or reactivated, or you're just plain old more sensitive to, are mold toxins called mycotoxins. A lot of us are exposed to those all the time, and it didn't— we don't notice it, but when we get really sick, if you're exposed in a moldy house, that will make you stay sick, or a moldy office environment, etc. Also, other toxic things like metal and chemical toxins that you may be exposed to at low levels aren't a problem in your day-to-day life until you get really sick, and then suddenly your toxin level, uh, in your body is very sensitive and, and it's too much. Okay. Now, so if we go through and We want to look at in the last section of the show. Okay, what do we want to think about if we're going to try and sort out long COVID and try and get through it? Well, one of the things to consider is it's almost— most of these things I've talked about are almost universal in a long COVID patient or post-COVID patient. What you want to think through is that The sicker you are as a long COVID patient, the more of these problems you need to be looking for. So we've got things like digestive system dysregulation, and that could be as simple as eating some prebiotic foods. You can go online, look up prebiotic— not probiotic, but prebiotic. They help set your digestive tract up for healing and stuff. You can take probiotics if that's something you and your healthcare provider decide are a good idea. And again, as I get into these ideas, I'm not giving you health advice. This is my personal experience and opinion. You should not get health advice from me or anybody else on YouTube or Facebook or anywhere. That's really a dumb idea. You should use this to educate yourself and then work with your healthcare team. And I can tell you, with long COVID or chronic illness of any kind, it's usually more than one healthcare provider needed to help you out. But there's just some general information. So again, don't go out and do anything because I say it's a good idea. Work with your healthcare provider to work on these things, and because they can guide you there. But GI dysregulation— now, if it's real bad, uh, because maybe you were on a lot of other medication during COVID You may have to do some more digestive system repair, but the digestive system repairs itself naturally all the time. And doing things like cutting out a lot of high-sugar foods, eating more prebiotic foods that help to engender better gut flora, maybe taking some probiotics or eating some, you know, cultured things, etc., that's usually enough to heal most people's Digestive systems. Nutrient depletion is universal, and here's the trouble: you don't notice putting nutrients back into your body today. Usually you need to think about repleting the nutrients from a bad viral illness over the course of 6 to 12 months after, because your body, in an effort not to die, uses up all of its resources. And even if you are taking nutrients during your illness, you're not going to have enough to rebuild everything. Now, this again is something that you should have some, you know, guidance with, but you're going to burn through all your water-soluble vitamins, minerals. All of those need to go in in a balanced way. Amino acids get low, other stuff. So you really need to look at high-density nutrition going back into your body and probably supplements to help refill the nutrients that your immune system sucked up. Now remember, in, in passing, go back on YouTube or your PodBurner and look at, you know, other infectious things we talked about. But your body, for example, burns up vitamin C faster than you can get it in when you're sick, especially the virus. It burns Burns through zinc. It does other things that are important. So vitamins and minerals are just critically important. And literally, if you get really, really sick, uh, you might need to work with somebody not only on your diet but also supplementation for 6 to 12 months. Now, that doesn't mean you're going to feel sick for 6 to 12 months. It means if you don't put those back in over that long of a time, you may take a long time to get better. The next thing, which you really do need, uh, you know, medical supervision for, but these are the most common things that I have seen when working with patients beyond nutrients, nutrition, and gut health, is, uh, the hormonal, uh, you know, problems that go on after you have a bad illness, especially like COVID. So one of the things your body does to try and keep you alive During an infection is it will often in the beginning upregulate your thyroid function and then crash. It'll take it down so that your thyroid, which runs your metabolic rate, your energy burn, will start to— goes up in the beginning when you're developing fever and other stuff like that, and it'll kind of take a rest and be suppressed. And your body has a mechanism for doing this. There's a number of things you test on thyroid after someone's been sick and they have a chronic, like a post-viral problem. But one of them is a remnant of the body's change in the hormone stuff called reverse T3, RT3. And T3 is a hormone. Reverse T3, I call it, it's like evil thyroid hormone. It goes in, it blocks the receptors. Well, your body does this not to be evil, but to slow down your metabolic rate, Well, the problem is your body sometimes doesn't get the message to stop doing this, and so we'll get people in there, reverse T3 will be super high, and you have to go in and do a short-term treatment with either natural things or thyroid hormone or something to kind of kickstart the system. Now, that again is not something you should do on your own, but it should be checked and looked into. The other thing that bounces around with your thyroid when you're really ill is your Cortisol, your adrenal hormones. Now, there's other corticoids from your adrenals, but cortisol is one that's easy to check. We usually do a morning blood draw on these folks and check their total cortisol. There's more elaborate cortisol tests, but you can start there. And normally your cortisol won't be gone because you'd be dead if you had no cortisol, but it'll be kind of on the low end. And so again, there might be natural things you can do or take to bring it up, or you might supplement it medically for a while. That's up to you and your healthcare provider. But if you had to pick 2 hormones which must be looked into in post-COVID, cortisol and thyroid are the most important. And with thyroid, you have to look at, you know, not just the thyroid, but did you make antibodies, uh, do you have reverse T3, and all these other things. Reproductive hormones tend to follow a pattern, and that pattern tends to be men or women, that progesterone goes down and testosterone goes down during illness. Not always, but tends to. Estrogen seems kind of insulated from this. So you, in men and women, you develop an estrogen dominance. The problem is that if your testosterone doesn't come back up, whether you're a woman or a man, your healing capacity stays low. If your progesterone doesn't come back up, whether you're a woman or you're a man, or a man, many things are a problem. But one big problem that progesterone is protective against is your brain. And remember all of that poking holes in the blood-brain barrier? One way to get out of that is, is by getting your progesterone back. The other thing is a lot of illness-related Sleep disturbance, anxiety, and other things can be low brain progesterone and then its relatives in the brain. So these things need to be looked at as well as something that you test. Fat-soluble vitamins like vitamin D and A, there's also vitamin E and K. They all, especially if you haven't been taking them, might need to be repleted afterwards. Again, you want to take a look at that, work with somebody on that. Checking for infections. Now, again, from the early days out of China, and I've put these into a lot of presentations since almost 2019. I mean, they've been in other pre-COVID presentations, but in February and March when I was starting to look at data, from this place called Wuhan, China, uh, and they were having this problem with this coronavirus that we weren't sure what it was, and they were doing all this stuff. One of the things they started to look at were what other infections did the real sick people have, and there were a lot of other infections. And that has borne itself out over and over and over. Everyone who looks for infections during COVID-19, during SARS-CoV-2 infection, they find other infections. So if you're still sick and you have long COVID and no one's looked for other infections, you should look for infections. Okay, now the ones that have been studied, like they say, cover every type of infection you can imagine— GI tract bugs, uh, bacteria, viruses, parasites, and fungus. One of the more common ones is a reactivation of Epstein-Barr virus. So you could have been negative before, but we've all been exposed to it, so we all keep a little bit around for, you know, old time's sake. And then you get really sick, Epstein-Barr virus comes back up, you will have a chronic fatigue-like syndrome. And a lot of the same symptoms that go along with long COVID are like EBV. Now Epstein-Barr is not the only— there's a— it's a family of, you know, 8 human viruses. It's in the middle of the family of 8 human viruses of one type only, but I found many of its relatives like CMV and other viruses elevated. The atypical pneumonias are very common, uh, the, the Mycoplasma family and Chlamydian pneumoniae. So we hear of chlamydia, you think of a sexually transmitted disease. That's a cousin of it. The Chlamydia pneumoniae is a respiratory bug usually, and we usually check for those together— Chlamydia and Mycoplasma pneumoniae. If you're still coughing a lot, it's really good to have some of the standard bugs checked, you know, like Strep pneumoniae. If you're diabetic, they usually check also for Klebsiella. There's other things, you know, Pseudomonas, many other bad bugs. But the sicker you are, the more, more of these infections you Check for systemic streptococcal problems. As I said, other viruses. And then, you know, the opportunistic fungus like Candida is very common to search during these. The bottom line is you find them and treat what you see. Toxins. Again, somebody who's really sick, good to check for toxins. I usually tell doctors that, you know, unless it's a real sick patient to start with, Work on the obvious stuff: hormones, nutrients, gut, and infections, and then go on. Brain things again. We talked about the imbalances in the neurosteroids, and then a friend of mine, Dr. Leonard Weinstock, and his crew just published a paper on multi on mast cell activation syndrome, and he published it in the in. International Journal of Infectious Disease, September 23rd, 2021, Leonard Weinstock. And again, that is mast cell activation syndrome. Now, MCS makes sense with post-COVID illness because the symptoms overlap. Mast cells are supposed to help us with infectious inflammatory response. When they go too far, we get this like wild allergic phenomenon and pain and inflammation. inflammation. Sound familiar? Well, mast cell activation goes along with these other inflammatory triggers, whether it's the furin problem or the kinin, the bradykinin problem, or all the other, you know, pro-inflammatory things. So it makes a lot of sense that mast cell activation is also over. So if you're a person who already knows you're super allergic or you have MCAS, And then you get COVID, you know, you're going to need extra work on that. But what's the most important thing about these inflammatory things? It's working on the stuff underneath that lowers the amplitude of your inflammation. So if you have infections, you work on them and get them cleared out. If you have toxins, you start to do things to get your body to release the toxins. If you have nutrient deficiencies, which you all do, uh, you work on those long, long term. If you have hormonal imbalances, you work on them. You don't just think about them. Okay, now, uh, I've had doctors especially say, well, geez, you know, am I going to test someone for all this stuff? Uh, no. Okay, there was a great paper, uh, written by a Dr. K-L-O-K, CLOCK. It has a score and you can do a CLOCK score. So if you look for K-L-O-K Post-COVID Functional Scale. So K-L-O-K is the lead author, and Post-COVID Functional Scale is, uh, the start of the paper name. You'll find it, and they published it in the European Respiratory Journal in 2020, so not that long ago. And they basically have grade 0 through grade 4. So what I tell doctors to do is grade the person first, like we would with, you know, cancer or or asthma or any other thing. And if they have a grade 0 or 1, do the basics. You're going to look at their gut healing, you're going to give them nutrients. Uh, if they got some remnant things and say there's a cough that won't go away, we'll check for the respiratory bugs, uh, and look for stuff. If they're in a grade 2, we're going to want to add on for sure checking, you know, hormonal things, uh, and maybe a little bit more on the you know, level of the infections and, you know, some of the other areas we talked about. If they're grade 3, we're going to pretty much check for everything. And certainly if they're grade 4, where they have severe functional limitations, you start out by checking everything. And I know that this goes against the way that a lot of us doctors think or like to think. There's nothing unusual about that. We're trained to think one way. which is about acute medicine. So that means you're sick, we, we stop you from dying, and you get better. Well, in COVID, that's not really the problem. When you get long COVID, you're sick, we stop you from dying, but now you're sick again. The sick again part is a chronic illness problem, and you have to take a step back and you have to say, yes, there's all these, you know, at least 15 things I talked about, and that's just a short list. of problems that go on and, and compensatory problems that go on, co-infections and nutrient deficiencies and hormone problems and maybe toxins and stuff. How do I sort it out? You use the CLOCK grading scale, K-L-O-C, you know, symptom scale. You decide, is it a small, medium, or a large problem? And then the bigger the problem, the more of those things you actually do testing for. and you then treat what you see. And if they're getting better, great. If they're not getting better, you widen your net and you look for more of these problems. Now, um, we are at the end of our time for today. I'm Dr. Paul Anderson, or Dr. A. This is Medicine Health with Dr. A. I'm answering your questions. When this gets over to YouTube, I will put a few links down into the, uh, description box where we put links on YouTube, and I will, I will link to some of the stuff that I've talked about. Obviously, the professional presentation I'm doing next week, I can't really link to that because it hasn't happened yet, but that will be at the American Academy of Environmental Medicine, and it will be a post-viral illness discussion with a focus on post-COVID. Where we will go into how, as a healthcare provider, do we address all of this. All right, I'm out of time for today. It's been my pleasure speaking with you, and we'll be back here, uh, live and also on YouTube next week with another installment of Medicine and Health with Dr. Paul Anderson. I'll see you then.